Department of Oral and Maxillofacial Surgery, University Hospital of Aachen, Aachen, Germany.
Institute of Laboratory Animal Science and Experimental Surgery of RWTH-Aachen, Aachen, Germany.
Microsurgery. 2022 Jul;42(5):480-489. doi: 10.1002/micr.30926. Epub 2022 Jun 7.
In free flaps, 5%-10% of complications are related to failure of sutured vascular anastomoses. Adhesive-based microvascular anastomoses are potential alternatives but are associated with failure rates of 70% in research studies. VIVO is a new adhesive with slow biodegradation within 6 months that has shown a 100% patency rate in research studies over 2 h observation time but long-term patency has not been evaluated. The authors hypothesize that VIVO will enable a reliable microvascular procedure comparable to sutured anastomoses over a 28-day period.
The right common carotid artery of 60 male Sprague Dawley rats, ~450 g, were used for microvascular end-to-end anastomosis. VIVO was applied with reduced sutures with a temporary catheter in one group and in the other with a custom-shaped memory stent. Anastomoses with eight interrupted sutures served as control. All groups were n = 20. Anastomosis time and bleeding were recorded for each procedure. Doppler flowmetry was performed 20 min, 1, 10, and 28 days postoperatively. Postmortem toluidine staining was used for semi-quantitative analysis of stenosis, thrombosis, necrosis, and aneurysm formation by histologic evaluation.
No occlusion was detected 20 min and 1 day postoperative, and after 28 days of observation in all anastomoses. The anastomosis time of the VIVO with catheter group was about 32% significantly faster than the VIVO with stent group. In the VIVO group with stent, the bleeding time was ~80% shorter than in the control group with 2.1 ± 0.3 and VIVO with catheter 2.0 ± 0.5 (p ≤ .001 each). Minor and nonsignificant stent-associated thrombus formation and stent-typical intraluminal stenosis were detected exclusively in the VIVO with stent group.
Within the limitations of a rat study, the use of VIVO in anastomosis showed promising results. VIVO with catheter was found to be advantageous.
在游离皮瓣中，5%-10%的并发症与缝合的血管吻合失败有关。基于黏附剂的微血管吻合术是一种潜在的替代方法，但在研究中失败率为 70%。VIVO 是一种新型黏合剂，其在 6 个月内缓慢生物降解，在 2 小时的观察时间内的研究中显示出 100%的通畅率，但尚未评估长期通畅率。作者假设 VIVO 将使微血管手术在 28 天内可靠，与缝合吻合术相当。
60 只雄性 Sprague Dawley 大鼠的右侧颈总动脉（约 450g）用于进行微血管端端吻合术。一组使用 VIVO 加减少的缝线和临时导管，另一组使用定制形状的记忆支架。用 8 个间断缝线进行吻合术作为对照。所有组均 n=20。记录每次手术的吻合时间和出血情况。术后 20 分钟、1 天、10 天和 28 天进行多普勒血流测量。死后甲苯胺蓝染色用于通过组织学评估进行半定量狭窄、血栓形成、坏死和动脉瘤形成分析。
在所有吻合术中，术后 20 分钟和 1 天均未发现闭塞，在 28 天的观察期内也未发现闭塞。VIVO 加导管组的吻合时间约快 32%，明显快于 VIVO 加支架组。在 VIVO 加支架组中，出血时间比对照组短约 80%，分别为 2.1±0.3 和 VIVO 加导管 2.0±0.5（p 均≤0.001）。仅在 VIVO 加支架组中检测到轻微的非支架相关血栓形成和支架典型的管腔内狭窄。
在大鼠研究的限制范围内，VIVO 在吻合术中的应用显示出有希望的结果。VIVO 加导管被发现具有优势。
