Sacak Bulent, Tosun Ugur, Egemen Onur, Sakiz Damlanur, Ugurlu Kemal
Department of Plastic Reconstructive and Aesthetic Surgery, Marmara University School of Medicine , Istanbul , Turkey.
J Plast Surg Hand Surg. 2015 Apr;49(2):72-6. doi: 10.3109/2000656X.2013.800528. Epub 2014 Dec 22.
Conventional anastomosis with interrupted sutures can be time-consuming, can cause vessel narrowing, and can lead to thrombosis at the site of repair. The amount of suture material inside the lumen can impair the endothelium of the vessel, triggering thrombosis. In microsurgery, fibrin sealants have the potential beneficial effects of reducing anastomosis time and promoting accurate haemostasis at the anastomotic site. However, there has been a general reluctance to use fibrin glue for microvascular anastomoses because the fibrin polymer is highly thrombogenic and may not provide adequate strength. To overcome these problems, a novel technique was defined for microvascular anastomosis with fibrin glue and a venous cuff. Sixty-four rats in two groups are included in the study. In the experimental group (n = 32), end-to-end arterial anastomosis was performed with two stay sutures, fibrin glue, and a venous cuff. In the control group (n = 32), conventional end-to-end arterial anastomosis was performed. Fibrin glue assisted anastomosis with a venous cuff took less time, caused less bleeding at the anastomotic site, and achieved a patency rate comparable to that provided by the conventional technique. Fibrin sealant assisted microvascular anastomosis with venous cuff is a rapid, easy, and reliable technique compared to the end-to-end arterial anastomosis.
采用间断缝合的传统吻合术可能耗时较长，会导致血管狭窄，并可能在修复部位引发血栓形成。管腔内的缝合材料量会损害血管内皮，引发血栓形成。在显微外科手术中，纤维蛋白密封剂具有减少吻合时间和促进吻合部位精确止血的潜在有益效果。然而，人们普遍不愿将纤维蛋白胶用于微血管吻合，因为纤维蛋白聚合物具有高度血栓形成性，且可能无法提供足够的强度。为克服这些问题，定义了一种使用纤维蛋白胶和静脉袖套进行微血管吻合的新技术。该研究纳入了两组共64只大鼠。在实验组（n = 32）中，采用两根定位缝线、纤维蛋白胶和静脉袖套进行端端动脉吻合。在对照组（n = 32）中，进行传统的端端动脉吻合。使用纤维蛋白胶并结合静脉袖套进行吻合所需时间更短，吻合部位出血更少，并实现了与传统技术相当的通畅率。与端端动脉吻合相比，使用纤维蛋白密封剂并结合静脉袖套进行微血管吻合是一种快速、简便且可靠的技术。
