• Archives of Plastic Surgery
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• v.47 no.3
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• pp.242-249
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• 2020

Background The Exoscope is a novel high-definition digital camera system. There is limited evidence signifying the use of exoscopic devices in microsurgery. This trial objectively assesses the effects of the use of the Exoscope as an alternative to the standard operating microscope (OM) on the performance of experts in a simulated microvascular anastomosis. Methods Modus V Exoscope and OM were used by expert microsurgeons to perform standardized tasks. Hand-motion analyzer measured the total pathlength (TP), total movements (TM), total time (TT), and quality of end-product anastomosis. A clinical margin of TT was performed to prove non-inferiority. An expert performed consecutive microvascular anastomoses to provide the exoscopic learning curve until reached plateau in TT. Results Ten micro sutures and 10 anastomoses were performed. Analysis demonstrated statistically significant differences in performing micro sutures for TP, TM, and TT. There was statistical significance in TM and TT, however, marginal non-significant difference in TP regarding microvascular anastomoses performance. The intimal suture line analysis demonstrated no statistically significant differences. Non-inferiority results based on clinical inferiority margin (Δ) of TT=10 minutes demonstrated an absolute difference of 0.07 minutes between OM and Exoscope cohorts. A 51%, 58%, and 46% improvement or reduction was achieved in TT, TM, TP, respectively, during the exoscopic microvascular anastomosis learning curve. Conclusions This study demonstrated that experts' Exoscope anastomoses appear non-inferior to the OM anastomoses. Exoscopic microvascular anastomosis was more time consuming but end-product (patency) in not clinically inferior. Experts' "warm-up" learning curve is steep but swift and may prove to reach clinical equality.

• Archives of Reconstructive Microsurgery
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• v.15 no.2
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• pp.51-57
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• 2006

Free flap having been used for reconstruction of skin and soft tissue defect in various areas in a body is spreading up its application for not only functional reconstruction but also aesthetic reconstruction. Authors met with good results minimizing the demerits of anastomosis using suture through microvascular anastomotic device, hereupon, we intend to report this. We worked with 27 cases that used microvascular anastomotic device for venous anastomoses among patients who were processed free flap in our hospital. Age ranged from 12 to 63 (average 43.2), and there were 12 females and 15 males. As a result of a follow-up by 3 months - 5years (average 11.3 months), there was no particular complication in the anastomosed vein except 1 cases among 27 cases that sutured their veins through microvascular anastomotic device. Use of microvascular anastomotic device at free flap shortened the time required for vascular anastomoses to reduce ischemic time of tissue, and minimized the damage of intima during anastomoses and made easy anastomoses possible even in case the difference of diameters of blood vessels being sutured is wide. As well, even for survival rate of flap, satisfactory results were obtained compared with using suture. Consequently, it is concluded that use of microvascular anastomotic device in free flap is a useful way that can substitute existing anastomosis using suture.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.12 no.1
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• pp.72-81
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• 1990

Because failure of microvascular flap grafting has sometimes been attributed to vascular obstruction in the anastomotic site, this study investigated the healing process after microvascular anastomoses. The healing process of anastomotic sites were observed by the use of the light and the scanning electron microscope after microvascular anastomoses of the right common carotid artery in rats. The experimental animals were sacrificed on the 4th day, 1st, 2nd, 4th and 6th week. Throughout the whole experimental period, arterial patency rate was 78% (11/14). At the early stage, it was possible to recognize histologically disappearance of endothelial cell and rupture of part of the media. Subintimal hyperplasia and the growth of media appeared around the suture line at the 2nd week. Endothelial cell regeneration occurred and the depth of vessel wall was normalized at the 4th week. By the scanning electron microscope, at the early stage, the anastomotic site was covered with many platelets, red blood cells, fibrins and macrophages. At the 4th week, the insertion site of the thread was completely covered with normal endothelial cells which were parallel to longitudinal axis of vessels and complete reendothelialization over the anastomotic site seemed to take about 6th week.

• The Journal of the Korean dental association
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• v.23 no.1 s.188
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• pp.73-81
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• 1985

In the assessment of patency of a small vessel anastomosis, micro-arteriography using dental X-ray and film was used as a method of testing the patency of arterial anastomoses in the rat. Micro-arteriography could lead to an objective evaluation of the patency in End-to-End and End-to Side anastomoses. The method used in this study is easily accessible for Oral and Maxillo-facial surgeon to practice the microvascular anastomosis, and requires materials available in every dental clinic.

• Archives of Plastic Surgery
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• v.46 no.3
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• pp.214-220
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• 2019

Background Microvascular anastomosis patency is adversely affected by local and systemic factors. Impaired intimal recovery and endothelial mechanisms promoting thrombus formation at the anastomotic site are common etiological factors of reduced anastomosis patency. Epigallocatechin gallate (EGCG) is a catechin derivative belonging to the flavonoid subgroup and is present in green tea (Camellia sinensis). This study investigated the effects of EGCG on the structure of vessel tips used in microvascular anastomoses and evaluated its effects on thrombus formation at an anastomotic site. Methods Thirty-six adult male Wistar albino rats were used in the study. The right femoral artery was cut and reanastomosed. The rats were divided into two groups (18 per group) and were systemically administered either EGCG or saline. Each group were then subdivided into three groups, each with six rats. Axial histological sections were taken from segments 1 cm proximal and 1 cm distal to the microvascular anastomosis site on days 5, 10, and 14. Results Thrombus formation was significantly different between the EGCG and control groups on day 5 (P=0.015) but not on days 10 or 14. The mean luminal diameter was significantly greater in the EGCG group on days 5 (P=0.002), 10 (P=0.026), and 14 (P=0.002). Intimal thickening was significantly higher on days 5 (P=0.041) and 10 (P=0.02). Conclusions EGCG showed vasodilatory effects and led to reduced early thrombus formation after microvascular repair. Similar studies on venous anastomoses and random or axial pedunculated skin flaps would also contribute valuable findings relevant to this topic.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.22 no.1
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• pp.22-32
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• 2000

Purpose : Histopathologic observation was performed in order to determine which type of suture material is superior in microvascular anastomoses. Materials & Methods : The interrupted end to end anastomosis of the transected carotid arteries of 105 Sprague-Dawley rats, weighing 180 to 200g, were performed using 9-0 polypropylene ($Prolene^{TM}$, Ethicon, U.K.), 9-0 polyglactin 910 monofilament($Vicryl^{TM}$, Ethicon, U.K.), and 9-0 polyamide($Ethilon^{TM}$, Ethicon, U.K.) under intramuscular Ketamine and Xylazine anesthesia(5mg/100g). In all cases, 10 to 12 sutures were placed to complete the anastomoses. The specimens were obtained at 1, 2, 3 days, and 1, 2, 4 and 6 weeks after the surgery and prepared with H&E and Van-Gieson stains and investigated the histologic changes in anastomotic sites under light microscope. The histologic changes we were concerned about were followings- thrombus formation, intimal edema, infiltration of inflammatory cells in media and adventitia, proliferation of endothelial cells and subintimal hyperplasia. Results : 1. All of the anastomosed arteries were patent when they were exposed for examination. 2. Thrombus formation and intimal edema were most severe in Vicryl group, followed by Ethilon, Prolene group in order. 3. The inflammatory cells infiltrated to the media and the adventitia most severely in Ethilon group, followed by Vicryl, Prolene group in order. 4. There was little difference in proliferation of endothelial cells in each group. 5. Subintimal hyperplasia was greater in Vicryl group than the others, but there was no significant difference between the Prolene and Ethilon groups. Conclusions : On the basis of these observations, we could conclude that Prolene may be the better suture material for microvascular anastomoses regarding the tissue responses than Ethilon and Vicryl.

• Archives of Reconstructive Microsurgery
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• v.8 no.1
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• pp.22-27
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• 1999

While the conventional end-to-end anastomotic technique is accepted as 'the golden standard' for microvascular anastomosis, it is time-consuming and tedious. In an effort to offer faster and safer ways of performing microvascular anastomoses, numerous anastomotic techniques have been proposed, but further refinements in microvascular techniques are still necessary. A 'continuous suture with interrupted knot' technique was devised for faster and safer anastomosis. It has been successfully used in microanastomoses of both artery and vein for free tissue transfer. It is a combination of the interrupted suturing technique and the continuous suturing technique. First, a continuous suture is made with the size of loop decreasing in order, and then the sutures are tied individually from the first loop to the last one as in the conventional interrupted suturing technique. It was applied clinically to fourteen patients over the past ten months and found to be a highly efficient technique that satisfied our needs. This 'continuous suture with interrupted knot' technique has several advantages over other techniques : The operative time is reduced comparing conventional interrupted suture technique. By delaying the tie and with the vessel walls kept separated, the risk of through-stitch can be reduced. Tying all the sutures at one time not only speed up the procedures, but also reduced the surgeon's fatigue. In addition, it has no problem of anastomotic stenosis which is a disadvantage of continuous suture technique. This technique proved to be faster and safer, and has patency equal to that of the conventional end-to-end anastomosis. It is of great help to the surgeon in reducing operative time, especially in clinical situations when many anastomoses are required, or lengthy grafting procedures are undertaken.

• Archives of Reconstructive Microsurgery
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• v.16 no.2
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• pp.53-56
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• 2007

Purpose: Microsurgical exercise has been performed with rat femoral vessels. But, it needs animal laboratory, anesthesia and its keeping facilities. Materials and Methods: Ten human placentas were studied for suitability in a microvascular exercise. The size and useful length of vessels were measured, and various microvascular anastomoses were performed. Result: The human placenta has many vessels traversing its fetal surface. A variety of sizes are available down to vessels of diameter 1 mm and up to vessels of diameter 6.5 mm (1.0

• Archives of Craniofacial Surgery
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• v.25 no.2
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• pp.95-98
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• 2024

Scalp avulsion is a devastating injury. The best possible procedure is replantation. Several successful scalp replantations with anastomoses of several vessels in large defects have been reported. In this report, we present a case of replantation of a large scalp avulsion using revascularizing with only one artery and vein. Despite the initial signs of flap congestion, we could predict the survival of the replanted scalp and terminate the procedure after detecting good perfusion and washout with indocyanine green fluorescence imaging. The procedure was successful following the patient's recovery of sensory and sweating functions without complications such as flap necrosis or infection. Several important factors for successful scalp replantation with positive esthetic and functional outcomes were considered.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.23 no.1
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• pp.1-6
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• 2001

Purpose : This study was undertaken to observe the occurrence of the vessel aneurysms according to several different methods of microvascular anastomosis. Mterials & methods : Forty Sprague-Dawley rats, weighing $180{\sim}200$ grams, were used for this experiment. The rats were divided into 4 groups. Group 1 (10 rats): The adventitia was trimmed off 5mm from the cut edge each and 20 arterial anastomoses were performed using 8 to 10 interrupted 9-0 polypropylene ($Prolene^{TM}$, Ethicon, U.K.) suture. Group 2 (10 rats): The adventitia was trimmed off as in group 1. Twenty arterial anastomoses were performed using continuous 9-0 polypropylene($Prolene^{TM}$, Ethicon, U.K.) suture. Group 3 (10 rats): The adventitia was stripped only 1mm from the cut edge each but not removed,. Twenty arterial anastomoses were performed using 8 to 10 interrupted 9-0 polypropylene($Prolene^{TM}$, Ethicon, U.K.) suture. Group 4 (10 rats): The adventitia was handled as in group 3. Twenty arterial anastomoses were performed using 9-0 polypropylene($Prolene^{TM}$, Ethicon, U.K.) suture. The arteries of the animals in all groups were explored at 28th days. We examined patency, presence of an aneurysm, other vascular abnormalities and microscopically observed the aneurysms with H&E and Van-Gieson stains. Result : 1. Patency rate was 80% in group 1, 95% in group 2, 85% in group 3 and 90% in group 4, respectively. 2. Aneurysm occurred 20% in group 1, 5% in group 2, 5% in group 3 and 5% in group 4, respectively. 3. There was no other vascular abnormalities in each group. 4. Infection rate was 5% in group 1, 0% in group 2, 20% in group 3 and 15% in group 4, respectively. 5. In the histopathological findings, we observed partially necrotic changes, loss and fragmentation of outer elastic lamella of smooth muscle in media and the proliferation of hyperplastic subintima. A lot of inflammatory cells were infiltrated in hyperplastic intima. Conclusions : On the basis of these observation, we could state that there were little differences in the occurrence of aneurysms according to different anastomotic suture methods.