From simple interrupted to complex spiral: A systematic review of various suture techniques for microvascular anastomoses

Abstract

Accomplishing successful microvascular anastomoses is undoubtedly one of the most critical steps in performing free tissue transfer. However, the ideal technique has often been a subject of debate. Therefore, our objective was to review the current literature in an attempt to find objective evidence supporting the superiority of one particular technique. A PubMed and OVID on-line search was performed in November 2007 using the following keywords: microvascular anastomoses, microsurgical anastomosis, continuous suture, interrupted suture, mattress suture, and sleeve anastomosis. Our literature review found no difference in short- and/or long-term patency rates between the six main published techniques, which includes continuous suture, interrupted suture, locking continuous, continuous horizontal, horizontal interrupted with eversion, and sleeve anastomoses. These findings were consistent for each technique as long as the microsurgeon maintained standard microsurgical principles and practice, including suture line eversion, minimized tension, and direct intima-to-intima contact. Current literature supports no overall statistical difference in short- and/or long-term patency rates between any of the various techniques. The choice to perform one suture technique over another ultimately depends on the plastic surgeon's preference and microsurgical experience. To date, there are no human randomized, controlled clinical trials comparing the efficacy and clinical outcomes of each of the various suture techniques, and therefore one's comfort and familiarity should dictate his or her microsurgical technique. However, "exposure to many and mastery of one" simply provides the plastic surgery resident, fellow, or staff the technical flexibility needed for less-complicated surgical planning when performing free tissue transfer.

Continuous versus interrupted suture technique in microvascular anastomosis in rats

“…They weighed 200-320g and were kept in a controlled environment with food and water ad libitum. The sample size was determined at the beginning of the study through specific statistical tests, based in previous studies [6][7][8][9] . The risk management standards α (5%) and β (10%) were considered, as well as the diversity of variables.…”

“…Mainly, because studies until 1960s demonstrated the superiority of this technique over the others suturing technique. However, after 1970s, a lot of studies refuted this data and reported similar patency rates using a continuous suture technique [4][5][6][7] .…”

“…Since the technique exerts compression circumferentially, anastomosis is less likely to leak. Nevertheless, it possesses certain disadvantages, such as lumen stenosis and formation of a rigid ring at the anastomosis site, as well as difficulties in elimination of vessel size discrepancy and leaves a greater amount of suture material in contact with the bloodstream, potentially leading to stasis and thrombosis 6,8,9 .…”

“…prolonged oozing duration and the longer time it requires for a successful anastomosis, which can be a compromising factor in prolonged cases of replantation or free tissue transfers [5][6][7] .…”

“…The most recent review of suture techniques in microvascular anastomosis shows that a statement cannot be made to favor either technique's patency rate and/or ease of performance when comparing endto-end and end-to-side configurations, mainly because there is no study in humans 6 . So, this study aims to comparing the continuous and interrupted suture technique in artery anastomosis in rats, search for influences at the patency and suture time after vessel repair and 14 days after.…”