Department of Neurosurgery, Showa General Hospital, Tokyo, Japan.
World Neurosurg. 2011 Jan;75(1):87-9. doi: 10.1016/j.wneu.2010.07.030.
We report a training technique of microvascular anastomosis readily accessible for trainees engaged in busy day-to-day clinical practice.
A table-top microscope is prepared on a table and 10-0 nylon suture (nonsterile) is used to tie two adjacent gauze fibers to form successive knots. In a second step, the knots are untied using the suture needle, which we call the knots untying technique (KUT). As the tied knots face different directions, it is difficult to guide the needle accurately through the knots without damaging or breaking the suture. And to untie all the knots within a certain time period, high controllability is required.
The practice of KUT will allow surgeons to improve their ability to accurately guide the needle from any direction and carry out precise suturing swiftly, which will prevent vascular wall dissection during microvascular anastomosis or inability to guide the needle to a target point because of physiologic tremor.
In our experience of training young neurosurgeons, practice of KUT contributes to shortening the duration of blood-flow blockage and helps mastering the technique of successful microvascular anastomosis.
我们报告了一种微血管吻合术的训练技术，适用于忙于日常临床实践的受训者。
在桌子上准备一个台式显微镜，并使用 10-0 尼龙缝线（非无菌）将两条相邻的纱布纤维系成连续的结。在第二步中，使用缝线针解开结，我们称之为结解开技术（KUT）。由于系紧的结面向不同的方向，因此很难在不损坏或断裂缝线的情况下准确地将针引导穿过结。并且要在一定时间内解开所有的结，需要高度的可控性。
KUT 的练习将使外科医生能够提高从任何方向准确引导针的能力，并迅速进行精确的缝合，这将防止在微血管吻合术中血管壁剥离，或由于生理震颤而无法将针引导到目标点。
在我们对年轻神经外科医生的培训经验中，KUT 的练习有助于缩短血流阻断的时间，并有助于掌握成功的微血管吻合技术。
