Microsurgical anastomosis with the 'PCA' technique

In this study, we introduce a new microvascular anastomosis technique called 'PCA' (Posterior wall first--Continuous interrupted--Airborne). The conventional microvascular anastomosis (CI), with single interrupted stitches, requires a long time to be completed, as each suture must be tied before starting the following stitch. Surgeons are often searching to reduce microsurgery time, particularly when there are multiple vessels to be anastomosed or when there is a prerequisite for the ischemia time to be quick.

The authors conducted a comparative study of PCA and CI on 40 Wistar-albino rats. The femoral arteries and veins of each rat were used, resulting in a total of 160 vessels, with a diameter of 0.8 to 1mm. The rats were divided into two groups. Patency rates were compared between the two groups, using the chi-square test. The times required to perform the anastomosis were compared using the Student's t test. A p value<0.001 was considered significant.

The mean time required for microvascular anastomosis of the femoral arteries was 22 minutes (mins) and 46 seconds (secs) in the PCA group, and 28 mins and 50 secs in the CI group. The mean time required for microvascular anastomosis of veins was 19 mins and 20 secs in the PCA group, and 23 mins and 36 secs in the CI group.

The combination of the three different techniques (posterior wall first, continuous-interrupted, and airborne), used for the microvascular anastomosis, is safe, secure, and time-saving. The advantages of this combined method are the benefits of a single stitch, the increased speed of a continuous suture, and the reduced time of tying. The PCA technique may be helpful to selected clinical situations, due to a reduction in microsurgical time, as in such cases of multiple digital replantations, multiple "in chain" free flaps, vein grafts, and high metabolic free flaps, such as the intestine free microvascular transfer.