An Open-Loop Technique to Facilitate Microtubal Anastomoses in the Rat

Lee, Sun; Hweidi, Sobhi A.; Skivolocki, William P.

doi:10.1055/s-2007-1007053

Cited by 11 publications

(10 citation statements)

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“…To decrease the circumference of the larger vessel, Lee et al proposed an open-loop differential bite technique in a rat model. 3 Their method was used clinically with good outcome in four patients with smaller discrepancies of 1.5:1 to 2:1 for breast reconstruction. 44 Another suturing technique employs unequal interrupted mattress sutures that bring the vessels together but this technique may create vessel wall folds that can promote thrombosis.…”

Section: Discussionmentioning

confidence: 99%

“…Multiple ETE microsurgical techniques including differential suture placement, 3 mechanical dilatation, 4 fishmouth incision, 5 oblique transection, 6 telescoping, 7,8 and tapering 5,9 have been described for addressing mild-tomoderate microvascular caliber discrepancies. However, the supporting studies are limited in that they often rely on animal models or small clinical series without significant postoperative follow-up to draw broad conclusions.…”

mentioning

confidence: 99%

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Modified Kunlin's Technique for Microsurgical End-to-End Anastomoses: A Series of 100 Flaps

Inbal

Collier

et al. 2019

J reconstr Microsurg

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Background In 1949, a French vascular surgeon, Jean Kunlin, first described a venous end-to-side anastomotic technique to address large vessel size mismatches. It was later modified by Dr. Robert Linton for end-to-end (ETE) anastomoses on the “macrovascular” scale. While multiple procedures exist for addressing moderate caliber discrepancies, few safely and reliably compensate for marked diameter differences at the microvascular level. In this study, we present the first large series adapting a modified geometric Kunlin's technique for arterial and venous ETE anastomoses in reconstructive microsurgery. Methods We reviewed 100 consecutive cases of free flap reconstructions from 2006 to 2015 utilizing a modified geometric Kunlin's technique for arterial and venous ETE anastomoses. Patient demographics and flap outcomes were analyzed. Overall flap survival rates and postoperative complications were analyzed and compared with standard values in the microsurgical literature. Results A total of 146 ETE anastomoses from 100 free flaps were analyzed. The average patient age was 51 ± 3.1 years (range: 10–84 years). Free flaps in this study were used for gender confirmation phalloplasties (20%) and reconstructing defects of the head and neck (63%), extremities (16%), and trunk (1%). There was a total of 17 takebacks including 5 for hematoma, 8 for anastomotic thromboses (6 venous), and 4 without any identifiable complication. Of these takebacks, two partial and two complete flap losses occurred. There was an 88% salvage rate for flaps requiring takebacks during the postoperative period. Overall, flap survival rate was 98% including those with complications or takebacks. Conclusion The modified Kunlin's technique is a reliable, facile, and versatile method of performing ETE anastomoses for arterial and venous vessels, especially with vessel diameter mismatches of 3:1 or greater, as well as for challenging orientations. Notably, it provides equivalent flap survival and complication rates as compared with other techniques in the microsurgical literature.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Modified Kunlin's Technique for Microsurgical End-to-End Anastomoses: A Series of 100 Flaps

Inbal

Collier

et al. 2019

J reconstr Microsurg

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“…In this technique, one can easily use the tips of the forceps to elevate the edge of the vessel [1,2]. This elevation not only enables one to see the lumen clearly at all times instead of counting on "feel" but also helps to evert the vessel edges avoiding adventitia and muscle layer inversion to the lumen.…”

Section: Open-loop Techniquementioning

confidence: 99%

“…Please note that the surgeon is able to use only one tip of the forceps even in very narrow suture intervals during anterior wall repair (thanks to open-loop technique) in order to elevate the right vessel edge for more secure anastomosis with better eversion. Another advantage of this technique is that it speeds up the anastomosis by 25% [1]. This anastomosis was performed in 8 minutes.…”

Section: Open-loop Techniquementioning

confidence: 99%

Improving Microvascular Anastomosis Efficiency by Combining Open-Loop and Airborne Suture Techniques

Sakarya¹

2018

IMJ

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“…Stay sutures are not useful for vessels under 3 mm in diameter. The loop technique as described by Lee et al 4 is useful to avoid piercing the opposite wall of the anastomosis, even if this rarely happens after well-conducted training. Comparison of continuous suture vs. interrupted suture was performed by Man and Acland in 1981, showing reduced time (5-7 vs. 12-18 minutes), but no other great differences were found.…”

Section: Arterial Anastomosesmentioning

confidence: 99%

Experimental models in microsurgery

et al. 1998

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The development of experimental microsurgery can be considered the natural evolution of a diffuse need to increase precision in many fields of surgery. Microsurgery accelerated the possibility of deepening many unclear aspects of pathophysiology, using miniaturized and reproducible experimental models. We report briefly on the fundamental principles of microsurgery and the most frequently performed and useful models of experimental microsurgery, especially to employ as training models for surgeons, but also as bases for developing new and always-welcome models.

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An Open-Loop Technique to Facilitate Microtubal Anastomoses in the Rat

Cited by 11 publications

References 0 publications

Modified Kunlin's Technique for Microsurgical End-to-End Anastomoses: A Series of 100 Flaps

Modified Kunlin's Technique for Microsurgical End-to-End Anastomoses: A Series of 100 Flaps

Improving Microvascular Anastomosis Efficiency by Combining Open-Loop and Airborne Suture Techniques

Experimental models in microsurgery

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