Qassemyar Q, Sinna R
Service de chirurgie plastique, reconstructrice et esthétique, hôpital Nord, CHU d'Amiens, place Victor-Pauchet, Amiens cedex 1, France.
Ann Chir Plast Esthet. 2011 Dec;56(6):518-27. doi: 10.1016/j.anplas.2010.11.003. Epub 2011 Jan 14.
Supermicrosurgical techniques developed for the anastomoses less or equal to 0.5mm show convincing results in specialized centers and with an advanced instrumentation. Can we integrate supermicrosurgical training animal models in the current teaching program of microsurgery?.
Ten arterial anastomoses of the inferior epigastric artery (diameter less than or equal to 0.5mm) were performed consecutively in five rats by the same beginner operator in microsurgery, with standard microsurgical set of instruments. The intravascular stenting anastomosis method was used with 11-0 nylon sutures. The immediate patency and flap survival on postoperative day three was assessed. The duration of each anastomosis was measured.
The mean diameter of the arteries was 0.4mm. The average time for each anastomosis was 30 minutes with a maximum of 55 minutes and a minimum of 18 minutes. The average number of stitches was 5.5. The immediate patency was 100 % with a 70 % success rate at the third day.
There are several applications of supermicrosurgical techniques, especially in hand surgery, lymphoedema surgical treatment and for perforator-to-perforator flaps. The intravascular stenting method allows fast learning of the technique with a satisfactory success rate despite non-specific instrumentation. Furthermore, this method could easily be integrated among the microsurgical courses of many universities.
为直径小于或等于0.5毫米的吻合术所开发的超显微外科技术，在专业中心和先进仪器设备的辅助下已展现出令人信服的效果。我们能否将超显微外科训练动物模型纳入当前的显微外科教学计划中？
同一位显微外科新手操作人员使用标准显微外科器械套装，在五只大鼠身上连续进行了十次腹壁下动脉吻合术（直径小于或等于0.5毫米）。采用血管内支架吻合术，使用11-0尼龙缝线。评估术后即刻通畅情况及术后第三天皮瓣存活情况。测量每次吻合术的持续时间。
动脉平均直径为0.4毫米。每次吻合术的平均时间为30分钟，最长55分钟，最短18分钟。平均缝合针数为5.5针。术后即刻通畅率为100%，第三天成功率为70%。
超显微外科技术有多种应用，尤其是在手外科、淋巴水肿手术治疗以及穿支皮瓣手术中。血管内支架吻合术方法能让学习者快速掌握该技术，尽管使用的并非专用仪器，但成功率令人满意。此外，该方法可轻松融入许多大学的显微外科课程中。
