Benlier Erol, Top Husamettin, Aygit A Cemal, Usta Ufuk, Unal Yasin
Department of Plastic, Reconstructive, and Aesthetic Surgery, Trakya University, Medical School, Edirne, Turkey.
J Reconstr Microsurg. 2007 Aug;23(6):311-5. doi: 10.1055/s-2007-985213.
The conventional technique of microvascular anastomosis may cause trauma to the vessel wall. In addition, the technique is difficult for beginners and is time consuming. The duration of ischemia is an important limiting factor for muscle transfer. In the case of multiple-digit replantations, fatigue developed in the surgeon may also result in suboptimal results. This study was performed to establish an easier and shorter method of microvascular anastomosis using the Arista hemostatic agent.
In this study, 20 carotid arteries obtained from rats were equally divided into two groups. The arteries were then divided and repaired using three simple interrupted stay sutures with Arista powder. Evaluations were performed using the following three methods: (1) clamping time during the vessel anastomosis, (2) patency test (after 1 hour, 24 hours, and 28 days), and (3) light microscopic findings.
The clamping time in the conventional suture anastomosis group was 21+/-4 minutes, whereas that of the minimal suture in the Arista group was 12+/-2 minutes; the difference between the two groups was statistically significant (P<.001). There was no significant difference between the patency rates of the two groups (P= .474). It was observed that the Arista group showed qualitatively less perivascular foreign-body giant cell reaction than the control group. There was no evidence of vascular mural fibrinoid necrosis, indicating that Arista was nontoxic for the vessel walls.
The Arista-assisted microvascular anastomosis is an alternative to the conventional suture-only method because it reduces the anastomosis time significantly and does not cause narrowing of the vessel wall. We believe that this technique has the potential for improving the performance of microvascular anastomosis in clinical practice.
传统的微血管吻合技术可能会对血管壁造成创伤。此外，该技术对初学者来说难度较大且耗时。缺血持续时间是肌肉移植的一个重要限制因素。在多指再植的情况下，外科医生的疲劳也可能导致效果欠佳。本研究旨在使用Arista止血剂建立一种更简便、耗时更短的微血管吻合方法。
在本研究中，从大鼠获取的20条颈动脉被平均分为两组。然后使用带有Arista粉末的三根简单间断定位缝线对动脉进行分割和修复。使用以下三种方法进行评估：（1）血管吻合过程中的夹闭时间，（2）通畅性测试（1小时、24小时和28天后），以及（3）光学显微镜检查结果。
传统缝线吻合组的夹闭时间为21±4分钟，而Arista组的最小缝线组为12±2分钟；两组之间的差异具有统计学意义（P<0.001）。两组的通畅率之间没有显著差异（P = 0.474）。观察到Arista组血管周围异物巨细胞反应在定性上比对照组少。没有血管壁纤维蛋白样坏死的证据，表明Arista对血管壁无毒。
Arista辅助微血管吻合术是传统单纯缝线方法的一种替代方法，因为它显著缩短了吻合时间且不会导致血管壁狭窄。我们认为该技术在临床实践中有改善微血管吻合性能的潜力。
