The cutting-edged microvascular needle

Using the scanning electron microscope (SEM), we compared the areas of endothelial disruption 45 minutes after penetration of rat femoral and carotid artery walls with 75- and 100-mu taper point and taper cut microsurgical needles, with and without restoration of blood flow. Four experimental groups were designated: needle puncture only, single loose, suture loop, end-to-end anastomosis, and end-to-side anastomosis. The vessels were perfused with normal saline, immersed in 3% buffered glutaraldehyde, and mounted under slight tension to simulate physiological wall distention before SEM examination. Endothelial craters at vessel puncture sites were measured on SEM photomicrographs at 300 X magnification. All vessels were patent when examined. Crater diameters averaged less than double the needle size. Although taper cut needles produced craters that were 25% larger (P less than 0.05), vessel penetration was easier than with the taper point needle and bleeding times were the same. Suture loop produced craters that were 36% larger (P less than 0.05) than needle puncture alone. Craters were 20% larger when blood flow was restored and 50% larger in the femoral than in the carotid artery. Although craters seen after end-to-end anastomosis were not significantly larger than those after end-to-side anastomosis, interrupted sutures appeared to cause more endothelial damage than continuous sutures. These results suggest that the use of cutting needles, passage and tying of sutures, vessel distention by blood flow, and suturing of more muscular and less elastic vessel walls (femoral artery) may increase endothelial disruption but do not reduce patency.

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Scanning electron microscopy studies of needle and suture damage in rat carotid and femoral arteries

Longa

Weinstein

Chater

1984

Microsurgery

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Re‐endothelialization stages at the microvascular anastomosis

1988

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After microsurgical suturing, the wound healing process at the rat femoral artery anastomosis was studied with scanning electron microscopy. The re-endothelialization was divided into four successive stages, based on the development of a fibrin network and the rate of endothelial regrowth. Within 5 minutes of blood flow re-establishment the fibrin network formation started to cover the wound surface; it was completed by the 3rd or 4th day. The endothelial recovery started on the 2nd day and continued to the base of the suture by the 6th day. Re-endothelialization from the wound edge, which was formed between intact and injured endothelium toward the suture-restrained site, was a two-fold process: initially, a single endothelial film covered the anastomosis site, then, the singled endothelial sheet proliferated and thickened to complete the endothelialization. A better understanding of the stages involved in microvascular repair is beneficial in evaluating vascular recovery and its relationship to patency rates in microvascular surgery.

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Wound healing at the site of microvascular anastomosis: Fibrin‐stabilizing factor XIII administration and its effects

et al. 1990

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Factor XIII has recently been recognized to play an important role as a fibrin-stabilizing factor to accelerate the wound healing process. We made an attempt to analyze the effect of how Factor XIII affects the results of the healing process at the site of a microvascular anastomosis. The strong fibrin stabilizing property of plasma Factor XIII maintained its high activity when administered intravenously and was effective for wound healing in a low-activity state made by subcutaneous administration of carbon tetrachloride. The enhanced network formation of the Factor-XIII-injected group was indicated by the accelerated maturation of the fibrin structure at the anastomotic site, exhibited both qualitatively and quantitatively. Stimulation and acceleration by Factor XIII of the healing process at the site of microvascular anastomosis were observed. It is therefore suggested that clinical use of Factor XIII may enhance the microvascular repair process. Details of the analysis using scanning electron microscopy (SEM) and a computerized graphic analyzer system (CGAS) are reported.

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The cutting-edged microvascular needle

Cited by 9 publications

References 5 publications

Scanning electron microscopy studies of needle and suture damage in rat carotid and femoral arteries

Scanning electron microscopy studies of needle and suture damage in rat carotid and femoral arteries

Re‐endothelialization stages at the microvascular anastomosis

Wound healing at the site of microvascular anastomosis: Fibrin‐stabilizing factor XIII administration and its effects

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