A new approximator used in microvascular anastomosis

Abstract

Microsurgery is a valuable discipline performed in many surgical practices. In literature, hundreds of studies dealing with different aspects of microsurgical practice including studies about new agents for anastomosis, different suturing materials and methods plus new models for surgical training, etc., 1-3 have been published. However, not much attention has been given to the newly developed microsurgical equipments. For decades, traditional clamps, microporteques, forceps, dilatators, and approximators have been slightly modified. [4][5][6][7][8] To bring a new dimension to this field, an interesting and a useful microvascular approximator which will be hopefully attractive for the microsurgeons, particularly for the beginners has been designed.The device is a simple, regular 1.8 cm double-microclamp based on a rectangular light green plate, which provides a complementary underground. There are three L-shaped flexible rods hinged on the base at 08, 908, and 1808. These rod ends have curved ends which help to hold sutures inside (Fig. 1). In addition, the main trunk of the double clamp is fixed to the base with two independent joints which enables the vessel in the clamps to move back and forth, up and down without distortion. This two way action of the approximator maintained by the simple double-joint system also prevents the vessel from getting out of the operative field when the vessel is rotated around itself (Fig. 2).Initially, distal and proximal ends of the vessel are identified. Routine steps like irrigation, dilatation, and adventitia removal are done as usual. After that, to place the vessel ends on the plate, third mobile rod, which is on the top is deplaced from its original position (Fig. 2a). First suture is placed at 08 and the suture is left long to be attached to the rod 1. Next suture is placed 1808 away from the first, and is attached to rod 2 in the same manner. Third suture is placed in the middle of previous sutures (908). After this step, the mobile rod (rod 3) is approximated to the top of the field and is connected to the 908 suture. This gives the vessel a tent-like shape where the back wall can be easily seen (Fig. 2b). Successive sutures are placed in between these stay sutures according to the vessel size and thus the front wall suturing is over now.Afterwards, first and second sutures which were attached to rods 1 and 2, respectively, are de-attached without cutting. However, the third suture connected to rod 3 is cut short and removed from the operative field (Fig. 3). Later, the double microclamp system is turned upside down with the help of the two-joint mobile system which prevents vessel distortion. Hence, the back wall can be clearly visualized (Fig. 2c). Zero and 1808 long suture ends are again attached to rods 1 and 2, respectively. Two hundred seventy degree suture is placed and as before, the third mobile rod is brought to the field for attachment. Other sutures are placed as described above. After carrying out these steps successfully, all the sutures are cut short, rod...

Microsutures Traction Device for Small Vessel Anastomosis

“…2 Clinically that means the possibility of replantation for fingertip amputations, flap harvest from a perforator vessel, and anastomosis to secondary branches (without sacrificing a major pedicle) or treatment of lymphedema by lymphovenular anastomosis. 3 To facilitate small caliber vessels anastomosis we have designed a microsutures traction device, which is easy to manufacture and use. The device is compound by a common contrast background, with two rods anchored on it.…”