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Toe-First Technique for End to Side Microvascular Anastomosis.
Gaurav Tyagi1, Dhaval Gohil1, Gyani Jail Singh Birua1
1Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India.
World Neurosurgery
|July 29, 2021
Summary
The toe-first (TF) technique for end-to-side (ES) microvascular anastomosis is feasible, demonstrating 100% patency in rat models. This method offers advantages in visualization and lumen adaptation during microsurgery.
Area of Science:
- Microsurgery
- Vascular Surgery
- Surgical Techniques
Background:
- End-to-side (ES) microvascular anastomosis commonly uses the 2-ends anchoring technique.
- Limited literature exists on the alternative toe-first (TF) technique for ES anastomoses.
Purpose of the Study:
- To present successful outcomes of the TF technique in ES microvascular anastomoses.
- To evaluate the feasibility and patency rates of the TF technique in a rat femoral vessel model.
Main Methods:
- ES microvascular anastomosis using the TF technique was performed on 10 Sprague Dawley rats.
- Two-throw reef knot interrupted sutures were employed.
- Immediate and delayed patency (2 weeks post-procedure) were assessed.
Main Results:
- Average suturing time was 40.14 minutes with an average of 14.57 sutures.
- Immediate patency rate was 100% (10/10 rats).
- Delayed patency rate was 100% in the 8 surviving rats after an average observation period of 29.6 days.
Conclusions:
- The TF interrupted suture technique for ES microvascular anastomosis is feasible.
- This technique achieves excellent immediate and delayed patency rates.
- Advantages include continuous recipient lumen visualization and avoidance of back-wall bites.
