Original Article 105
Does Open Guide Suture Technique Improve the Patency Rate in Submillimeter Rat Artery Anastomosis? Kann die Open Guide Nahttechnik die Durchgängigkeitsrate von arteriellen Anastomosen im Submillimeterbereich bei Ratten verbessern? Authors
B. O. Mofikoya1, A. O. Ugburo1, O. B. Bankole2
Affiliations
1
Department of Surgery, Burns, Plastic Surgery and Hand Rehabilitation Unit, College of Medicine, University of Lagos, Lagos, Nigeria 2 Department of Surgery, Neurosurgery Unit, College of Medicine, University of Lagos, Lagos, Nigeria
Key words ▶ open ● ▶ guide ● ▶ suture ● ▶ anastomosis ● ▶ microsurgery ●
Abstract
Zusammenfassung
Objective: The anastomosis of sub-millimeter vessels is fraught with significant technical challenges even for the experienced microsurgeon. The supermicrosurgery era is increasing the demand for repair of very small vessels. Our study aims to ascertain whether the open guide suture technique provides a superior patency rate compared with conventional technique when anastomosing rat artery less than a millimeter. Methods: Anastomosis of transected rat femoral, superficial femoral and central tail arteries were done in 24 in bred albino rats. The external diameters ranged from 0.4 mm to 0.8 mm. The repair was assigned into the Open guide suture technique group or the conventional group (n = 12 in each group). The duration of repair, grade of leakage, patency of the repair at 30 min were noted and compared between the groups. Results: The patency rate was 92.7 % in each group. There was no statistically significant difference between the 2 groups with respect to anastomotic times, grade of leakage external diameter and type of vessel repaired (p-values > 0.05). Conclusion: It appears open guide suture technique simplifies repair but may not offer a better patency rate in rat arterial anastomosis under 1 mm when compared to the conventional technique.
Ziel: Anastomosen im Submillimeterbereich sind auch für den erfahrenen Mikrochirurgen eine signifikante technische Herausforderung. In der Ära der Supermikrochirurgie werden immer kleinere Gefäße anastomosiert. Ziel der Studie war der Vergleich der Durchgängigkeitsrate bei Anwendung der Open Guide Nahttechnik im Vergleich zur konventionellen Technik bei Anastomosen von Rattenarterien im Submillimeterbereich. Methode: Bei 24 Albinoratten wurden folgende durchtrennte Gefäße re-anastomosiert: A. femoralis, die A. femoralis superficialis und die Arteria caudalis centralis. Die äußeren Gefäßdurchmesser lagen bei 0,4–0,8 mm. Bei jeweils n = 12 Tieren wurde die Open Guide oder die konventionelle Anastomosetechnik angewandt. Reparaturdauer, Leckagegrad und Durchgängigkeit nach 30 min wurden dokumentiert und zwischen beiden Gruppen verglichen. Ergebnisse: Die Durchgängigkeitsrate lag bei 92,7% in beiden Gruppen. Zwischen den Gruppen fand sich kein signifikanter Unterschied bezüglich der Anastomosezeiten, dem Leckagegrad, den externen Gefäßdurchmessern und dem rekonstruierten Gefäßtypus (p-Wert > 0,05). Schlussfolgerung: Obschon die Open Guide Nahttechnik die Gefäßreparatur zu vereinfachen scheint, ermöglicht sie keine höheren Durchgängigkeitsraten im Vergleich zur konventionellen Technik bei arteriellen Anastomosen < 1 mm in der Ratte.
Introduction
ensuring patency rates become more important. Although some have argued that the clinical values of such skill is marginal, super-microsurgery skills, as this is known, are highly valuable in fingertip replantation, perforator flap surgery as well lymphaticovenular anastomosis for lymphedema [2, 3]. This skill is also of significant value in experimental microsurgery. The key limitation in the repair of these very small ves-
received accepted
8.6.2013 24.7.2013
Bibliography DOI http://dx.doi.org/ 10.1055/s-0033-1353195 Handchir Mikrochir Plast Chir 2014; 46: 105–107 © Georg Thieme Verlag KG Stuttgart · New York ISSN 0722-1819 Correspondence Dr. Bolaji Oyawale Mofikoya Department of Surgery Burns, Plastic and Hand Rehabilitation Unit College of Medicine University of Lagos Idiaraba Lagos Lagos Nigeria [email protected]
▼
Microvascular reconstruction is premised on the repair of small vessels, from its beginnings in the late 1960s, it has transformed the practice of plastic and reconstructive surgery and has advanced the frontiers of virtually all surgical disciplines [1]. With anastomoses of vessels of less than 1 mm, technical accuracy of repair and
▼
Mofikoya BO et al. Does Open Guide Suture … Handchir Mikrochir Plast Chir 2014; 46: 105–107
Downloaded by: Universite Laval. Copyrighted material.
Schlüsselwörter ▶ offen ● ▶ Führung ● ▶ Naht ● ▶ Anastomose ● ▶ Mikrochirurgie ●
▼
106 Original Article
Materials and Methods
▼
24 inbred albino laboratory rats with a mean weight of 374 g were used. They were fed and cared for at the animal laboratory department of the College of Medicine, University of Lagos. Each animal was anaesthetized with intraperitoneal ketamine. All procedures were done by one author BOM (who had completed 50 sub-millimeter anastomoses before this study). The femoral, superficial, femoral and central tail arteries of the rats were transected, provided that the external diameters were below 1 mm. Each repair was then systematically assigned to the conventional or the open guide suture technique method, the transected ends were then repaired. Each procedure was timed, the type of anastomosis, grade of leakage (1 = leakage that stopped without intervention, 2 = leakage that stopped with gentle digital pressure, 3 = leakage that required reclamping and
additional sutures), number of sutures placed and the rate of ▶ Table 1). All patency 30 min after the repairs were recorded (● animal handling conformed to the guidelines on the care and use of laboratory animals published by the National Academy of Science.
The conventional technique 2 stay sutures were placed 120 ° apart and tied. The anterior row of sutures was then placed in series. The vessel was then flipped 180 ° to place the last triangulating stay suture at 120 ° to the previous ones. Each half of the posterior row of sutures was then completed in series.
Open guide suture technique The first suture is placed at the far end of the vessel, the second suture is placed at the near end and left untied 180 ° from the first one. The sutures are then sequentially placed starting from the first one using the untied suture as a guide to lumen visuali▶ Fig. 1). The zation always until the anterior wall is completed (● vessel is then turned 180 ° and a midline posterior suture is placed but left untied. The other sutures are then placed starting from the edges towards the untied suture until the anastomosis is completed.
Results
▼
24 anastomosis were done, 12 repairs in each group. 12 femoral arteries, 7 central arteries of the tail, and 5 superficial femoral arteries were used in the study. In each group there was 1 failed anastomosis. The vessel sizes ranged from 0.4 mm to 0.8 mm with a mean of 0.62 mm SD ± 0.12 mm. The range of the anastomosis time was from 12.4 min to 24.8 min with a mean of 18.03 min. For the open suture guide group the mean anastomo-
Table 1 Summary of the experiments and results. Rat no. (artery)
External diameter
Type of anastomosis
(mm) 1 (CAT) 2 (FA) 3 (FA) 4 (CAT) 5 (FA) 6 (FA) 7 (CAT) 8 (FA) 9 (SFA) 10 (CAT) 11 (FA) 12 (SFA) 13 (CAT) 14 (FA) 15 (FA) 16 (SFA) 17 (FA) 18 (FA) 19 (SFA) 20 (CAT) 21 (CAT) 22 (FA) 23 (CAT) 24 (SFA)
0.5 0.7 0.8 0.6 0.8 0.6 0.7 0.6 0.4 0.6 0.6 0.4 0.7 0.6 0.7 0.5 0.8 0.7 0.4 0.6 0.7 0.5 0.6 0.5
conventional conventional OGST conventional conventional OGST OGST OGST OGST conventional OGST OGST conventional conventional conventional conventional conventional OGST OGST OGST conventional OGST OGST OGST
Duration of
Grade of
No. of
anastomosis (min)
leakage
sutures
30 min
23 18 16 12 21 12 18 18 17 15 21 18 19 22 13 20 24 19 18 19 21 19 15 20
2 2 3 1 1 1 1 1 1 1 2 – 1 0 – 2 2 2 1 2 2 1 1 1
8 8 7 7 9 8 9 8 5 9 7 6 8 6 8 4 8 8 4 6 7 8 7 6
yes yes yes yes yes yes yes yes yes yes yes no yes yes no yes yes yes yes yes yes yes yes yes
FA = femoral artery, SFA = superficial femoral artery, CAT = central artery of tail, OGST = open guide suture technique
Mofikoya BO et al. Does Open Guide Suture … Handchir Mikrochir Plast Chir 2014; 46: 105–107
Patency at
Downloaded by: Universite Laval. Copyrighted material.
sels remains the risk of technical errors. This is due to inadvertent catching of the posterior wall attributable to poor lumen visualization. Although several methods have been described to overcome this and improve the patency rate, few have compared these methods in sub-millimeter vessels. The intravascular stenting technique uses an intraluminal, appropriately sized nylon suture as a stent to improve lumen visualization, while in the temporary suspension suture technique, advential sutures are used temporarily to manipulate the vessel edges into an open position [4, 5]. Open guide suture technique uses an untied suture end as guide to constant lumen visualization, minimizing the risk of accidental back wall suture and has been said to be the most practical of all the techniques [6, 7]. Our study aims to determine whether this technique improves the patency rate of the anastomosis when compared with the conventional gold standard.
Original Article 107
Fig. 1 Open guide suture technique showing the open second stay suture used as a guide.
sis time was 17.7 min SD ± 2.42 min. In the conventional group the meantime was 18.9 min SD ± 3.7 min. There was no significant difference between these: sigma (2 tail) > 0.05. The mean grade of leakage was 1.25 for the open suture guide group and 1.33 for the conventional group, this was however not statistically significant. It was also found that the patency rate was not affected by the type of vessel, grade of leak, anastomosis time, external diameter of the vessel: sigma (2 sided) > 0.05.
Discussion
▼
While the conventional suture method is the gold standard in the anastomosis of large vessels (external diameter > 1 mm), it tends to be difficult in smaller vessels [7]. Here the 2 anterior stay sutures make a clear lumen virtually impossible to see, making many microsurgeons “guess” the exact position of the lumen and so increasing the risk of the accidental back wall stitch while placing the anterior row of sutures. While several techniques have been described to ensure patency in these vessels, the open guide suture technique appears to be the fastest, and the least cumbersome with no special aids being required. It uses the untied second stay suture as a guide to the surgeon allowing constant lumen visualization and accurate suture placement at all times. In the original description the posterior midline third stay suture is also left untied to guide the placement of the remaining posterior row of sutures. We found that the patency rates of both the conventional and the suture guide technique were the same (92.7 %) in our study. This is similar to the work of Miyamoto [8] who found no significant differences in the patency rates for conventional, open suture guide technique and intravascular stenting method in the repair of rat superficial epigastric artery (external diameter less than 0.5 mm). It does appear that other factors such as the microsurgeon’s experience may play a more important role than technique of repair in sub-millimeter vessel anastomosis. We also found that there was no significant differences in the anastomotic times, the degree of leakage and the number of sutures required between the 2 groups. This is also supported by
Bolaji O Mofikoya born April 1969. Trained at the College of Medicine University of Lagos, Nigeria (1990). Residency training in Plastic Surgery at the Lagos University Teaching Hospital (2000). Microsurgery fellowship at Chang Gung Memorial Hospital, Taipei, Taiwan (2004). Hand and microsurgery fellowship was at the National University Hospital, Singapore (2006). Clinical trainings in Brachial plexus surgery and peripheral nerve reconstruction at Texas Nerve and Paralysis Institute, Houston, USA 2007, Hand Division of Orthopaedic Surgery Department Mayo Clinic, Minnesota USA 2011, Reconstructive Microsurgery unit St Franzciscus Hospital Aachen Germany 2013. Currently Head of the Hand section of the Plastic surgery unit of the Lagos University Teaching hospital in Lagos, Nigeria. Senior Lecturer at the Department of Surgery, College of Medicine University of Lagos. Major research interests are peripheral nerve injuries, microreconstructions and experimental microsurgery. Dr Bolaji Mofikoya Senior Lecturer/Consultant Hand and Plastic surgeon Hand rehabilitation, Burns and Plastic Surgery unit, College of Medicine University of Lagos/Lagos University teaching hospital PMB 12003 Lagos, Nigeria.
Conflict of interest: None References 1 Chao JJ, Castello JR, English JM et al. Microsurgery: free tissue transfer and replantation. Sel Read Plast Surg 2000; 9: 1–32 2 Koshima I, Inagawa K, Yamamoto M et al. New microsurgical breast reconstruction using free paraumbilical perforator adiposal flaps. Plast Reconstr Surg 2000; 106: 61–65 3 Koshima I, Inagawa K, Urushibara K et al. Supermicrosurgical lymphaticovenular anastomosis for the treatment of lymphedema in the upper extremities. J Reconstr Microsurg 2000; 16: 437–442 4 Narushima M, Koshima I, Mihara M et al. Intravascular stenting (IVaS) for safe and precise supermicrosurgery. Ann Plast Surg 2008; 60: 41e4 5 Ulusal AE, Ulusal BG, Hung LM et al. Temporary assisting suspension suture technique for successful microvascular anastomosis of extremely small and thin walled vessels for mice transplantation surgery. Plast Reconstr Surg 2005; 116: 1438e41 6 Ozkan O, Ozgentas HE. Open guide suture technique for safe microvascular anastomosis. Ann Plast Surg 2005; 55: 289e91 7 Lee S, Frank DH, Choi SY. Historical review of small and microvascular vessel surgery. Ann Plast Surg 1983; 11: 53 8 Miyamoto M, Sakuraba S, Asano T et al. Optimal technique for microvascular anastomosis of very small vessels: comparative study of three techniques in a rat superficial inferior epigastric arterial flap model. J Plast Reconstr Aesthet Surg 2010; 63: 1196–1201
Mofikoya BO et al. Does Open Guide Suture … Handchir Mikrochir Plast Chir 2014; 46: 105–107
Downloaded by: Universite Laval. Copyrighted material.
Miyamoto’s findings [8]. We acknowledge that our small sample size, the exclusion of similar caliber veins and short-term evaluation of patency rates are limitations of this study, while the experience of the microsurgeon as well is likely to influence the findings. As such while recommending the open suture guide technique in repairing vessels under 1 mm, the microsurgeon’s experience may be of more importance than the technique of repair in these vessels.
Does Open Guide Suture Technique Improve the Patency Rate in Submillimeter Rat Artery Anastomosis? Kann die Open Guide Nahttechnik die Durchgängigkeitsrate von arteriellen Anastomosen im Submillimeterbereich bei Ratten verbessern? Authors
B. O. Mofikoya1, A. O. Ugburo1, O. B. Bankole2
Affiliations
1
Department of Surgery, Burns, Plastic Surgery and Hand Rehabilitation Unit, College of Medicine, University of Lagos, Lagos, Nigeria 2 Department of Surgery, Neurosurgery Unit, College of Medicine, University of Lagos, Lagos, Nigeria
Key words ▶ open ● ▶ guide ● ▶ suture ● ▶ anastomosis ● ▶ microsurgery ●
Abstract
Zusammenfassung
Objective: The anastomosis of sub-millimeter vessels is fraught with significant technical challenges even for the experienced microsurgeon. The supermicrosurgery era is increasing the demand for repair of very small vessels. Our study aims to ascertain whether the open guide suture technique provides a superior patency rate compared with conventional technique when anastomosing rat artery less than a millimeter. Methods: Anastomosis of transected rat femoral, superficial femoral and central tail arteries were done in 24 in bred albino rats. The external diameters ranged from 0.4 mm to 0.8 mm. The repair was assigned into the Open guide suture technique group or the conventional group (n = 12 in each group). The duration of repair, grade of leakage, patency of the repair at 30 min were noted and compared between the groups. Results: The patency rate was 92.7 % in each group. There was no statistically significant difference between the 2 groups with respect to anastomotic times, grade of leakage external diameter and type of vessel repaired (p-values > 0.05). Conclusion: It appears open guide suture technique simplifies repair but may not offer a better patency rate in rat arterial anastomosis under 1 mm when compared to the conventional technique.
Ziel: Anastomosen im Submillimeterbereich sind auch für den erfahrenen Mikrochirurgen eine signifikante technische Herausforderung. In der Ära der Supermikrochirurgie werden immer kleinere Gefäße anastomosiert. Ziel der Studie war der Vergleich der Durchgängigkeitsrate bei Anwendung der Open Guide Nahttechnik im Vergleich zur konventionellen Technik bei Anastomosen von Rattenarterien im Submillimeterbereich. Methode: Bei 24 Albinoratten wurden folgende durchtrennte Gefäße re-anastomosiert: A. femoralis, die A. femoralis superficialis und die Arteria caudalis centralis. Die äußeren Gefäßdurchmesser lagen bei 0,4–0,8 mm. Bei jeweils n = 12 Tieren wurde die Open Guide oder die konventionelle Anastomosetechnik angewandt. Reparaturdauer, Leckagegrad und Durchgängigkeit nach 30 min wurden dokumentiert und zwischen beiden Gruppen verglichen. Ergebnisse: Die Durchgängigkeitsrate lag bei 92,7% in beiden Gruppen. Zwischen den Gruppen fand sich kein signifikanter Unterschied bezüglich der Anastomosezeiten, dem Leckagegrad, den externen Gefäßdurchmessern und dem rekonstruierten Gefäßtypus (p-Wert > 0,05). Schlussfolgerung: Obschon die Open Guide Nahttechnik die Gefäßreparatur zu vereinfachen scheint, ermöglicht sie keine höheren Durchgängigkeitsraten im Vergleich zur konventionellen Technik bei arteriellen Anastomosen < 1 mm in der Ratte.
Introduction
ensuring patency rates become more important. Although some have argued that the clinical values of such skill is marginal, super-microsurgery skills, as this is known, are highly valuable in fingertip replantation, perforator flap surgery as well lymphaticovenular anastomosis for lymphedema [2, 3]. This skill is also of significant value in experimental microsurgery. The key limitation in the repair of these very small ves-
received accepted
8.6.2013 24.7.2013
Bibliography DOI http://dx.doi.org/ 10.1055/s-0033-1353195 Handchir Mikrochir Plast Chir 2014; 46: 105–107 © Georg Thieme Verlag KG Stuttgart · New York ISSN 0722-1819 Correspondence Dr. Bolaji Oyawale Mofikoya Department of Surgery Burns, Plastic and Hand Rehabilitation Unit College of Medicine University of Lagos Idiaraba Lagos Lagos Nigeria [email protected]
▼
Microvascular reconstruction is premised on the repair of small vessels, from its beginnings in the late 1960s, it has transformed the practice of plastic and reconstructive surgery and has advanced the frontiers of virtually all surgical disciplines [1]. With anastomoses of vessels of less than 1 mm, technical accuracy of repair and
▼
Mofikoya BO et al. Does Open Guide Suture … Handchir Mikrochir Plast Chir 2014; 46: 105–107
Downloaded by: Universite Laval. Copyrighted material.
Schlüsselwörter ▶ offen ● ▶ Führung ● ▶ Naht ● ▶ Anastomose ● ▶ Mikrochirurgie ●
▼
106 Original Article
Materials and Methods
▼
24 inbred albino laboratory rats with a mean weight of 374 g were used. They were fed and cared for at the animal laboratory department of the College of Medicine, University of Lagos. Each animal was anaesthetized with intraperitoneal ketamine. All procedures were done by one author BOM (who had completed 50 sub-millimeter anastomoses before this study). The femoral, superficial, femoral and central tail arteries of the rats were transected, provided that the external diameters were below 1 mm. Each repair was then systematically assigned to the conventional or the open guide suture technique method, the transected ends were then repaired. Each procedure was timed, the type of anastomosis, grade of leakage (1 = leakage that stopped without intervention, 2 = leakage that stopped with gentle digital pressure, 3 = leakage that required reclamping and
additional sutures), number of sutures placed and the rate of ▶ Table 1). All patency 30 min after the repairs were recorded (● animal handling conformed to the guidelines on the care and use of laboratory animals published by the National Academy of Science.
The conventional technique 2 stay sutures were placed 120 ° apart and tied. The anterior row of sutures was then placed in series. The vessel was then flipped 180 ° to place the last triangulating stay suture at 120 ° to the previous ones. Each half of the posterior row of sutures was then completed in series.
Open guide suture technique The first suture is placed at the far end of the vessel, the second suture is placed at the near end and left untied 180 ° from the first one. The sutures are then sequentially placed starting from the first one using the untied suture as a guide to lumen visuali▶ Fig. 1). The zation always until the anterior wall is completed (● vessel is then turned 180 ° and a midline posterior suture is placed but left untied. The other sutures are then placed starting from the edges towards the untied suture until the anastomosis is completed.
Results
▼
24 anastomosis were done, 12 repairs in each group. 12 femoral arteries, 7 central arteries of the tail, and 5 superficial femoral arteries were used in the study. In each group there was 1 failed anastomosis. The vessel sizes ranged from 0.4 mm to 0.8 mm with a mean of 0.62 mm SD ± 0.12 mm. The range of the anastomosis time was from 12.4 min to 24.8 min with a mean of 18.03 min. For the open suture guide group the mean anastomo-
Table 1 Summary of the experiments and results. Rat no. (artery)
External diameter
Type of anastomosis
(mm) 1 (CAT) 2 (FA) 3 (FA) 4 (CAT) 5 (FA) 6 (FA) 7 (CAT) 8 (FA) 9 (SFA) 10 (CAT) 11 (FA) 12 (SFA) 13 (CAT) 14 (FA) 15 (FA) 16 (SFA) 17 (FA) 18 (FA) 19 (SFA) 20 (CAT) 21 (CAT) 22 (FA) 23 (CAT) 24 (SFA)
0.5 0.7 0.8 0.6 0.8 0.6 0.7 0.6 0.4 0.6 0.6 0.4 0.7 0.6 0.7 0.5 0.8 0.7 0.4 0.6 0.7 0.5 0.6 0.5
conventional conventional OGST conventional conventional OGST OGST OGST OGST conventional OGST OGST conventional conventional conventional conventional conventional OGST OGST OGST conventional OGST OGST OGST
Duration of
Grade of
No. of
anastomosis (min)
leakage
sutures
30 min
23 18 16 12 21 12 18 18 17 15 21 18 19 22 13 20 24 19 18 19 21 19 15 20
2 2 3 1 1 1 1 1 1 1 2 – 1 0 – 2 2 2 1 2 2 1 1 1
8 8 7 7 9 8 9 8 5 9 7 6 8 6 8 4 8 8 4 6 7 8 7 6
yes yes yes yes yes yes yes yes yes yes yes no yes yes no yes yes yes yes yes yes yes yes yes
FA = femoral artery, SFA = superficial femoral artery, CAT = central artery of tail, OGST = open guide suture technique
Mofikoya BO et al. Does Open Guide Suture … Handchir Mikrochir Plast Chir 2014; 46: 105–107
Patency at
Downloaded by: Universite Laval. Copyrighted material.
sels remains the risk of technical errors. This is due to inadvertent catching of the posterior wall attributable to poor lumen visualization. Although several methods have been described to overcome this and improve the patency rate, few have compared these methods in sub-millimeter vessels. The intravascular stenting technique uses an intraluminal, appropriately sized nylon suture as a stent to improve lumen visualization, while in the temporary suspension suture technique, advential sutures are used temporarily to manipulate the vessel edges into an open position [4, 5]. Open guide suture technique uses an untied suture end as guide to constant lumen visualization, minimizing the risk of accidental back wall suture and has been said to be the most practical of all the techniques [6, 7]. Our study aims to determine whether this technique improves the patency rate of the anastomosis when compared with the conventional gold standard.
Original Article 107
Fig. 1 Open guide suture technique showing the open second stay suture used as a guide.
sis time was 17.7 min SD ± 2.42 min. In the conventional group the meantime was 18.9 min SD ± 3.7 min. There was no significant difference between these: sigma (2 tail) > 0.05. The mean grade of leakage was 1.25 for the open suture guide group and 1.33 for the conventional group, this was however not statistically significant. It was also found that the patency rate was not affected by the type of vessel, grade of leak, anastomosis time, external diameter of the vessel: sigma (2 sided) > 0.05.
Discussion
▼
While the conventional suture method is the gold standard in the anastomosis of large vessels (external diameter > 1 mm), it tends to be difficult in smaller vessels [7]. Here the 2 anterior stay sutures make a clear lumen virtually impossible to see, making many microsurgeons “guess” the exact position of the lumen and so increasing the risk of the accidental back wall stitch while placing the anterior row of sutures. While several techniques have been described to ensure patency in these vessels, the open guide suture technique appears to be the fastest, and the least cumbersome with no special aids being required. It uses the untied second stay suture as a guide to the surgeon allowing constant lumen visualization and accurate suture placement at all times. In the original description the posterior midline third stay suture is also left untied to guide the placement of the remaining posterior row of sutures. We found that the patency rates of both the conventional and the suture guide technique were the same (92.7 %) in our study. This is similar to the work of Miyamoto [8] who found no significant differences in the patency rates for conventional, open suture guide technique and intravascular stenting method in the repair of rat superficial epigastric artery (external diameter less than 0.5 mm). It does appear that other factors such as the microsurgeon’s experience may play a more important role than technique of repair in sub-millimeter vessel anastomosis. We also found that there was no significant differences in the anastomotic times, the degree of leakage and the number of sutures required between the 2 groups. This is also supported by
Bolaji O Mofikoya born April 1969. Trained at the College of Medicine University of Lagos, Nigeria (1990). Residency training in Plastic Surgery at the Lagos University Teaching Hospital (2000). Microsurgery fellowship at Chang Gung Memorial Hospital, Taipei, Taiwan (2004). Hand and microsurgery fellowship was at the National University Hospital, Singapore (2006). Clinical trainings in Brachial plexus surgery and peripheral nerve reconstruction at Texas Nerve and Paralysis Institute, Houston, USA 2007, Hand Division of Orthopaedic Surgery Department Mayo Clinic, Minnesota USA 2011, Reconstructive Microsurgery unit St Franzciscus Hospital Aachen Germany 2013. Currently Head of the Hand section of the Plastic surgery unit of the Lagos University Teaching hospital in Lagos, Nigeria. Senior Lecturer at the Department of Surgery, College of Medicine University of Lagos. Major research interests are peripheral nerve injuries, microreconstructions and experimental microsurgery. Dr Bolaji Mofikoya Senior Lecturer/Consultant Hand and Plastic surgeon Hand rehabilitation, Burns and Plastic Surgery unit, College of Medicine University of Lagos/Lagos University teaching hospital PMB 12003 Lagos, Nigeria.
Conflict of interest: None References 1 Chao JJ, Castello JR, English JM et al. Microsurgery: free tissue transfer and replantation. Sel Read Plast Surg 2000; 9: 1–32 2 Koshima I, Inagawa K, Yamamoto M et al. New microsurgical breast reconstruction using free paraumbilical perforator adiposal flaps. Plast Reconstr Surg 2000; 106: 61–65 3 Koshima I, Inagawa K, Urushibara K et al. Supermicrosurgical lymphaticovenular anastomosis for the treatment of lymphedema in the upper extremities. J Reconstr Microsurg 2000; 16: 437–442 4 Narushima M, Koshima I, Mihara M et al. Intravascular stenting (IVaS) for safe and precise supermicrosurgery. Ann Plast Surg 2008; 60: 41e4 5 Ulusal AE, Ulusal BG, Hung LM et al. Temporary assisting suspension suture technique for successful microvascular anastomosis of extremely small and thin walled vessels for mice transplantation surgery. Plast Reconstr Surg 2005; 116: 1438e41 6 Ozkan O, Ozgentas HE. Open guide suture technique for safe microvascular anastomosis. Ann Plast Surg 2005; 55: 289e91 7 Lee S, Frank DH, Choi SY. Historical review of small and microvascular vessel surgery. Ann Plast Surg 1983; 11: 53 8 Miyamoto M, Sakuraba S, Asano T et al. Optimal technique for microvascular anastomosis of very small vessels: comparative study of three techniques in a rat superficial inferior epigastric arterial flap model. J Plast Reconstr Aesthet Surg 2010; 63: 1196–1201
Mofikoya BO et al. Does Open Guide Suture … Handchir Mikrochir Plast Chir 2014; 46: 105–107
Downloaded by: Universite Laval. Copyrighted material.
Miyamoto’s findings [8]. We acknowledge that our small sample size, the exclusion of similar caliber veins and short-term evaluation of patency rates are limitations of this study, while the experience of the microsurgeon as well is likely to influence the findings. As such while recommending the open suture guide technique in repairing vessels under 1 mm, the microsurgeon’s experience may be of more importance than the technique of repair in these vessels.
