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A modified technique of end-to-side microvascular anastomosis for the posterior wall
Masahiro Nakagawa1, Keita Inoue, Takuya Iida
1Division of Plastic and Reconstructive Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan. m.nakagawa@scchr.jp
Abstract:
A modified technique of interrupted suturing for the posterior wall in end-to-side microvascular anastomosis is presented. It has advantages, especially for the suturing of the pedicle vein and the internal jugular vein in head and neck reconstructions when the pedicle vessel is so short that it cannot be turned over to expose the posterior wall. The pedicle vein is located vertical to the internal jugular vein, and the first stitch begins at the left end of the vessels for a right-handed person. To facilitate the exposure of the left edge of the vessels, the donor vessel is rotated approximately 90 degrees. The advantage of our technique is clear visualization of each suture by rotating the pedicle vessel. Subsequent to the interrupted suturing of the posterior wall, the anterior wall can be sutured by conventional methods. This modified technique is useful for end-to-side microvascular anastomosis, which the microsurgeon may find useful.
Insights
This study presents a modified interrupted suturing technique for end-to-side microvascular anastomosis, improving posterior wall visualization, especially in head and neck reconstructions with short pedicle veins.
Area of Science:
- Microsurgery
- Vascular Surgery
- Surgical Techniques
Background:
- End-to-side microvascular anastomosis is crucial for reconstructive surgery.
- Challenges exist in suturing the posterior wall, particularly with short pedicle vessels.
- Limited visualization of the posterior wall can complicate head and neck reconstructions.
Purpose of the Study:
- To introduce a modified interrupted suturing technique for the posterior wall of end-to-side microvascular anastomosis.
- To address the challenges of suturing short pedicle veins in head and neck reconstructions.
- To enhance visualization and precision during microvascular anastomosis procedures.
Main Methods:
- A modified interrupted suturing technique for the posterior wall is described.
- The technique involves rotating the pedicle vessel approximately 90 degrees for improved exposure.
- The first stitch is initiated at the left end of the vessels for right-handed surgeons.
Main Results:
- The modified technique provides clear visualization of each suture during posterior wall suturing.
- Facilitates anastomosis when the pedicle vessel is too short for conventional exposure.
- Allows for subsequent conventional suturing of the anterior wall.
Conclusions:
- This modified interrupted suturing technique offers a practical solution for end-to-side microvascular anastomosis.
- It is particularly beneficial for head and neck reconstructions involving short pedicle veins.
- The technique enhances surgical precision and may be a valuable addition to microsurgical practice.
