Technology-assisted and sutureless microvascular anastomoses: evidence for current techniques.

Area of Science:

• Microsurgery
• Vascular Surgery
• Surgical Technology

Background:

• Reconstructive microvascular surgery aims to reduce operative time while maintaining efficacy.
• Various devices have been developed to assist in microsurgical anastomoses.
• This review evaluates current technologies and supporting evidence.

Purpose of the Study:

• To investigate available technologies for assisted microvascular anastomoses.
• To provide objective evidence supporting the use of these devices.
• To compare the efficacy of different anastomotic techniques.

Main Methods:

• Searched Medline and Pubmed databases for microvascular anastomosis techniques.
• Assessed publications based on Oxford Centre for Evidence Based Medicine criteria.
• Focused on studies with quantifiable endpoints like return to theatre, flap salvage, and complication rates.

Main Results:

• A lack of high-level evidence exists for most assisted microvascular anastomosis methods.
• No randomized prospective trials directly compare these techniques.
• Retrospective cohort studies show advantages for Unilink™/3M™ coupler and Autosuture™ VCS® clip applicator (Level 2b evidence).

Conclusions:

• Level 2b evidence supports the Unilink™/3M™ coupler and Autosuture™ VCS® clip applicator for assisted microvascular anastomoses.
• Techniques like cyanoacrylates, fibrin glues, Medtronic™ U-Clip®, and laser bonding have limited supporting evidence.
• Further research is needed to define the role of other assisted anastomosis techniques.