Improved microvessel repair: Laser welding with an anti‐thrombotic solder

Stewart, Robert B.; Bass, Lawrence S.; Thompson, Jeffrey K.; Nikoi, Naa Dei; Becker, Glenn; Kung, R. T. V.

doi:10.1002/lsm.10071

Cited by 5 publications

(5 citation statements)

References 20 publications

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“…The ratio of vascular thrombosis reported in free flap surgery varies between 5.1% and 9.9% (11-13), and for the prevention of this complication, in addition to the suggestions of agents such as botulinum toxins, low molecular weight heparins, aspirin, prostaglandins, dextran inhibitors, and other various agents (14)(15)(16)(17)(18)(19)(20)(21)(22), studies on anastomosis have also been carried out (23)(24)(25)(26)(27)(28)(29).…”

Section: Discussionmentioning

confidence: 99%

An Attempt to Keep Flaps Alive with Artificial Perfusion in Rabbits

Özyazgan¹,

Idaci²,

Kontaş³

2016

Erciyes Med J

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Objective: In free flap surgery, the condition of recipient vessels may not be appropriate for anastomosis because of anatomical factors or acquired features such as tumoral invasion, surgical treatment, or radiotherapy. Furthermore, free flap surgery is time-consuming, expensive, demanding, and more prone to complications. The aim of this study was to test the hypothesis that maintaining free flap perfusion with a temporary artificial system without microanastomosis until revascularization is adequate for flap vitality. Materials and Methods:We studied a total of 14 rabbits, which were placed into two groups: control and experimental. A 5×5 cm free skin island flap was elevated on the caudolateral scapular region. In the experimental group, the artery and vein of the flaps were cannulated and a 5 cc/h plasma infusion was artificially started prior to flap fixation. In the control group, the flaps were designed and sutured to the recipient area without perfusion.Results: The animals did not live long enough for us to analyze the maintenance of the clinical flap vitality. However, it was found that flap tissues in the experimental group were vital during the first 6 days after surgery, while composite graft tissues in the control group resulted in necrosis on day 3 in histopathological examination.Conclusion: Our experimental model proves that the artificial flap perfusion model with plasma perfusion extends the duration of tissue viability compared with that with non-perfusion (control group). This result could be improved with further investigations and may lead to the development of many future innovations.

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Section: Discussionmentioning

confidence: 99%

An Attempt to Keep Flaps Alive with Artificial Perfusion in Rabbits

Özyazgan¹,

Idaci²,

Kontaş³

2016

Erciyes Med J

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“…Moreover, the development of albumin-based solution solders allowed higher biocompatibility between its proteinaceous structure and collagen fibers. As its application is possible with different variations in composition, this solder solution is the most common in these procedures The materials referred to above improve the technical parameters and reduce the thermal damage, enabling the achievement of higher weld strength [43,46,72,76]. Menosky et al [45] concluded that the amount and concentration of structural proteins is directly correlated with the bonding strength of the welded repair.…”

Section: Welding Parameters and Bonding Conditionsmentioning

confidence: 99%

“…Moreover, the development of albumin-based solution solders allowed higher biocompatibility between its proteinaceous structure and collagen fibers. As its application is possible with different variations in composition, this solder solution is the most common in these procedures [40,46,72,76]. For example, BioGlue, which is composed of 45% bovine serum albumin and 10% glutaraldehyde, cross-links with tissue fibers through chemical bindings, allowing vascular chemical stabilization of sutured and welded sites [58].…”

Section: Welding Parameters and Bonding Conditionsmentioning

confidence: 99%

“…In turn, Barton et al [40] confirmed the possibility of including support cross-linking agents, such as genipin, in albumin-based solutions to improve their flexibility and reduce brittleness. The improvement of solder properties by adding other elements had already been tested some years earlier by Stewart et al [76], who introduced heparin in an albumin-based solder with the purpose of reducing microvessel thromboses. More recently, Hiebl et al [78] reported the effectiveness of using carrier membranes with bovine serum albumin (BSA) solder linked by covalent cross-linking bindings and indocyanine green (ICG) dye to improve bonding strength and to prevent liquid solder leakage.…”

Section: Appl Sci 2019 9 X For Peer Review 9 Of 15mentioning

confidence: 99%

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Overview on the Evolution of Laser Welding of Vascular and Nervous Tissues

2019

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Laser welding presents a core position in the health sector. This process has had an outstanding impact on the surgical procedures from many medical areas, such as on vascular and nervous surgeries. The aim of the present research is to present an overview on the evolution of laser welding of vascular and nervous tissues. These surgeries present many advantages, such as an absence of foreign-body reactions and aneurysms and good tensile strengths. However, despite the sutureless nature of the process, complementary sutures have been applied to support the procedure success. An important concern in vascular and nervous laser welding is the thermal damage. The development of temperature-controlled feedback systems has reduced this concern with a very precise control of the laser parameters. The bonding strength of vascular and nerve laser welds can be enhanced with the application of solder solutions, bonding materials, and laser-activated dyes. Alternative techniques to laser welding, such as photochemical tissue bonding and electrosurgical high-frequency technologies, have also been tested for vascular and nervous repairs.

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“…Additionally, in an in vivo setting, genipin has the potential to increase resilience to cell-mediated and enzymatic degradation [111,118]. Future application in the clinical setting should consider employing a concentrated autologous plasma protein [119][120][121]. However, the higher denaturation temperature of HSA might require higher lasing parameters, which increases the risk of inflicting more extensive thermal damage [52].…”

Section: Future Perspectivesmentioning

confidence: 99%

Laser-assisted vessel welding: state of the art and future outlook

Pabittei

Boon

Heger

et al. 2015

JCTRes

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Laser-assisted vascular welding (LAVW) is an experimental technique being developed as an alternative to suture anastomosis. In comparison to mechanical anastomosis, LAVW is less traumatic, non-immunogenic, provides immediate water tight sealant, and possibly a faster and easier procedure for minimally invasive surgery. This review focuses on technical advances to improve welding strength and to reduce thermal damage in LAVW. In terms of welding strength, LAVW has evolved from the photothermally-induced microvascular anastomosis, requiring stay sutures to support welding strength, to sutureless anastomoses of medium-sized vessels, withstanding physiological and supraphysiological pressure. Further improvements in anastomotic strength could be achieved by the use of chromophore-containing albumin solder and the employment of (biocompatible) polymeric scaffolds. The anastomotic strength and the stability of welds achieved with such a modality, referred to as scaffold-and solder-enhanced LAVW (ssLAVW), are dependent on the intermolecular bonding of solder molecules (cohesive bonding) and the bonding between solder and tissue collagen (adhesive bonding). Presently, the challenges of ssLAVW include (1) obtaining an optimal balance between cohesive and adhesive bonding and (2) minimizing thermal damage. The modulation of thermodynamics during welding, the application of semi-solid solder, and the use of a scaffold that supports both cohesive and adhesive strength are essential to improve welding strength and to limit thermal damage.

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Improved microvessel repair: Laser welding with an anti‐thrombotic solder

Abstract: Solders incorporating heparin should provide in situ anti-thrombotic therapy reducing the risk of microvascular thromboses.

Cited by 5 publications

References 20 publications

An Attempt to Keep Flaps Alive with Artificial Perfusion in Rabbits

An Attempt to Keep Flaps Alive with Artificial Perfusion in Rabbits

Overview on the Evolution of Laser Welding of Vascular and Nervous Tissues

Laser-assisted vessel welding: state of the art and future outlook

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