Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York.
Department of Pathology and Cell Biology, Columbia University, New York, New York.
J Reconstr Microsurg. 2020 Sep;36(7):486-493. doi: 10.1055/s-0040-1709453. Epub 2020 Apr 17.
Successful microvascular anastomosis depends on sutures that adequately oppose both cut vessel edges. Trainees tend to take oversized or uneven bite. To improve early microsurgical skill acquisition using the rat, this study tests the belief that such bites compromise early patency by applying exaggerated bites to end-to-end arterial anastomoses.
Twelve Sprague-Dawley rats were randomly assigned to one of the four bite techniques to be applied to both femoral arteries (mean diameter, 0.8 mm). Large (L) and standard (S) bites measured 1.0 and 0.2 mm from the edge, respectively. Eight simple interrupted anastomoses were performed per bite technique, each labeled according to every proximal end bite size, followed by every distal end bite size: LL, LS, SL, and SS. Anastomosis time and blood flow rates were recorded and analyzed statistically. After sacrifice 5 days postoperation, anastomosis sections of each technique were examined histologically.
All 24 anastomoses (100%) maintained patency for 5 days. There was no statistical difference between all postoperative blood flow measurements at any given time. Anastomosis times using LL, LS, SL, and SS bite techniques were 41.6, 33.2, 34.8, and 25.5 minutes, respectively. Anastomosis time for the traditional bite technique (SS) was significantly shorter than all other bite techniques ( < 0.05). Histological examination of the harvested segments from each group revealed similar pathophysiological features.
Oversized bites (1 mm), placed symmetrically and asymmetrically across the anastomosis, do not affect early patency in the rat femoral artery. A reduced reliance on conventional guidelines for suture bites appears acceptable during microarterial anastomoses if the goal is vessel patency. However, we believe clinical competence involves the ability to place small, even bites consistently and uniformly. During microsurgical training, the occasional large bite need not be replaced; however, the trainee should be encouraged to take standard bites.
成功的微血管吻合取决于能够充分对抗切割血管边缘的缝线。受训者往往会采用过大或不均匀的咬合。为了通过在端端动脉吻合术中应用夸张的咬合来提高大鼠的早期显微外科技能，本研究检验了这样的咬合会通过早期通畅来损害吻合的信念。
将 12 只 Sprague-Dawley 大鼠随机分配到四种咬合技术中的一种，用于吻合双侧股动脉（平均直径 0.8mm）。大（L）和标准（S）咬合分别从边缘测量 1.0mm 和 0.2mm。每种咬合技术均进行 8 个简单间断吻合，每个吻合均根据近端每个咬合大小和远端每个咬合大小进行标记：LL、LS、SL 和 SS。记录吻合时间和血流速度，并进行统计学分析。术后 5 天处死大鼠后，检查每种技术的吻合部位进行组织学检查。
所有 24 个吻合口（100%）均保持通畅 5 天。在任何给定时间，所有术后血流测量均无统计学差异。采用 LL、LS、SL 和 SS 咬合技术的吻合时间分别为 41.6、33.2、34.8 和 25.5 分钟。传统咬合技术（SS）的吻合时间明显短于其他所有咬合技术（<0.05）。对每组采集的标本进行组织学检查显示出相似的病理生理特征。
在大鼠股动脉中，对称和不对称放置的过大咬合（1mm）不会影响早期通畅。如果目标是血管通畅，则在微动脉吻合术中，减少对缝线咬合常规指南的依赖是可以接受的。然而，我们认为临床能力包括能够一致且均匀地放置小而均匀的咬合的能力。在显微外科培训中，偶尔采用大的咬合不需要替代；但是，应该鼓励受训者采用标准的咬合。
