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J Reconstr Microsurg 2017; 33(06): 426-434
DOI: 10.1055/s-0037-1599101
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

A New Supermicrosurgery Training Model of Saphenous Artery and Great Saphenous Vein Anastomosis for Development of Advanced Microsurgical Skills

Can Emre Bas
1   Department of Orthopaedics, University of Illinois at Chicago, Chicago, Illinois
,
Joanna Cwykiel
1   Department of Orthopaedics, University of Illinois at Chicago, Chicago, Illinois
,
Maria Siemionow
1   Department of Orthopaedics, University of Illinois at Chicago, Chicago, Illinois
› Author Affiliations
Further Information

Publication History

26 October 2016

07 January 2017

Publication Date:
10 March 2017 (online)

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Abstract

Background This study aimed to confirm the feasibility and reliability of saphenous artery (SA) and great saphenous vein (GSV) anastomosis as a new supermicrosurgery training model and to compare the one-way-up anastomosis with the currently used end-to-end anastomosis technique.

Methods Twenty supermicrosurgical anastomoses were performed in 10 Sprague Dawley rats. The external diameters of SA and GSV were measured using Leica LAS EZ software. The right-side SA and GSV anastomoses were performed using the standard end-to-end anastomosis technique. The left-side SA and GSV anastomoses were performed using the one-way-up technique with 11–0 monofilament-interrupted sutures. The duration of the surgery, patency rates, and technical challenges of the two anastomoses methods were compared.

Results The mean external diameters of SA and GSV were 0.273 ± 0.03 and 0.291 ± 0.02 mm, respectively, which qualify these vessels for supermicrosurgical training. The vessels were easily accessible and both anastomosis techniques were feasible. The one-way-up technique was proven to be faster as compared with the end-to-end anastomosis technique (artery: 34 ± 2.55 vs. 40.4 ± 2.97 minutes, p = 0.02; and vein: 37 ± 4.85 vs. 44 ± 2.35 minutes, p = 0.05, respectively). Short-term patency rates for arteries and veins were 100% for both techniques. Seven-day anastomosis patency rates for arteries and veins were 80 and 100% for the end-to-end technique and 100 and 80% for the one-way-up technique, respectively.

Conclusions We confirmed that saphenous pedicle is suitable for creating a supermicrosurgery training model for practicing the ultrafine motor skills. To the best of our knowledge, this is the first report on supermicrosurgery of SA and GSV in the rat model.

Keywords

one-way-up anastomosis technique - supermicrosurgery training model - saphenous artery and great saphenous vein
 

  • References

  • 1 Kim JS, Choi TH, Kim NG. , et al. The replantation of an amputated tongue by supermicrosurgery. J Plast Reconstr Aesthet Surg 2007; 60 (10) 1152-1155
    CrossrefPubMedGoogle Scholar
  • 2 Stupka I, Dvorak Z, Vesely J, Novak P, Perrotta RE, Lombardo GA. Reconstruction of a nose bitten and eaten by a dog: a ten-year follow-up of a bitten-off nose replantation performed on an eleven-year-old boy. Ann Plast Surg 2015; 75 (06) 585-587
    CrossrefPubMedGoogle Scholar
  • 3 Kim S, Jeong H, Choi TH, Kim JS. Successful re-plantation of an amputated nasal segment by supermicrosurgery: a case report and review of the literature. J Plast Reconstr Aesthet Surg 2010; 63 (04) e380-e383
    CrossrefPubMedGoogle Scholar
  • 4 Hong JP. The use of supermicrosurgery in lower extremity reconstruction: the next step in evolution. Plast Reconstr Surg 2009; 123 (01) 230-235
    CrossrefPubMedGoogle Scholar
  • 5 Fujitsu M. Pulp flap replantation of the amputated fingertip. Plast Reconstr Surg 2011; 127 (03) 77e-78e
    CrossrefPubMedGoogle Scholar
  • 6 Nagase T, Gonda K, Inoue K. , et al. Treatment of lymphedema with lymphaticovenular anastomoses. Int J Clin Oncol 2005; 10 (05) 304-310
    CrossrefPubMedGoogle Scholar
  • 7 Hino A. Training in microvascular surgery using a chicken wing artery. Neurosurgery 2003; 52 (06) 1495-1497 , discussion 1497–1498
    CrossrefPubMedGoogle Scholar
  • 8 Chen WF, Eid A, Yamamoto T, Keith J, Nimmons GL, Lawrence WT. A novel supermicrosurgery training model: the chicken thigh. J Plast Reconstr Aesthet Surg 2014; 67 (07) 973-978
    CrossrefPubMedGoogle Scholar
  • 9 Yonekawa Y, Roth P, Taub E, Imhof HG. Laboratory training in microsurgical techniques and microvascular anastomosis. Oper Tech Neurosurg 1999; 2 (03) 149-158
    CrossrefPubMedGoogle Scholar
  • 10 Matsumura N, Endo S, Hamada H, Kurimoto M, Hirashima Y, Takaku A. An experimental model for side-to-side microvascular anastomosis. J Reconstr Microsurg 1999; 15 (08) 581-583
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 National Research Council. Guide for the Care and Use of Laboratory Animal Resources. 8th ed. Washington, DC: National Academies Press; 2011
    Google Scholar
  • 12 Ad-El DD, Harper A, Hoffman LA. Digital replantation teaching model in rats. Microsurgery 2000; 20 (01) 42-44
    CrossrefPubMedGoogle Scholar
  • 13 Mutaf M, Tasaki Y, Tanaka K, Fujii T. The rat saphenous flap: a fasciocutaneous free flap model without panniculus carnosus. Ann Plast Surg 1995; 35 (04) 402-408
    CrossrefPubMedGoogle Scholar
  • 14 Green EC. The Anatomy of the Rat. New York, NY: Hafner Publishing Co.; 1955
    Google Scholar
  • 15 Masia J, Olivares L, Koshima I. , et al. Barcelona consensus on supermicrosurgery. J Reconstr Microsurg 2014; 30 (01) 53-58
    PubMedGoogle Scholar
  • 16 Choi DH, Goh T, Cho JY, Hong JP. Thin superficial circumflex iliac artery perforator flap and supermicrosurgery technique for face reconstruction. J Craniofac Surg 2014; 25 (06) 2130-2133
    CrossrefPubMedGoogle Scholar
  • 17 Gurnaney HG, Fiadjoe JE, Levin LS. , et al. Anesthetic management of the first pediatric bilateral hand transplant. Can J Anaesth 2016; 63 (06) 731-736
    CrossrefPubMedGoogle Scholar
  • 18 Brännström M, Bokström H, Dahm-Kähler P. , et al. One uterus bridging three generations: first live birth after mother-to-daughter uterus transplantation. Fertil Steril 2016; 106 (02) 261-266
    CrossrefPubMedGoogle Scholar
  • 19 Suh HS, Oh TS, Hong JP. Innovations in diabetic foot reconstruction using supermicrosurgery. Diabetes Metab Res Rev 2016; 32 (Suppl. 01) 275-280
    CrossrefPubMedGoogle Scholar
  • 20 Qassemyar Q, Gianfermi M. Supermicrosurgery and hyaluronic acid: experimental feasability study of a new method. Ann Chir Plast Esthet 2015; 60 (01) e59-e65
    CrossrefPubMedGoogle Scholar
  • 21 Mofikoya BO, Ugburo AO, Bankole OB. Does open guide suture technique improve the patency rate in submillimeter rat artery anastomosis?. Handchir Mikrochir Plast Chir 2014; 46 (02) 105-107
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Sucher R, Lin CH, Zanoun R. , et al. Mouse hind limb transplantation: a new composite tissue allotransplantation model using nonsuture supermicrosurgery. Transplantation 2010; 90 (12) 1374-1380
    CrossrefPubMedGoogle Scholar
  • 23 Kisu I, Mihara M, Banno K. , et al. A new surgical technique of uterine auto-transplantation in cynomolgus monkey: preliminary report about two cases. Arch Gynecol Obstet 2012; 285 (01) 129-137
    CrossrefPubMedGoogle Scholar
  • 24 Usón J, Calles MC. Design of a new suture practice card for microsurgical training. Microsurgery 2002; 22 (08) 324-328
    CrossrefPubMedGoogle Scholar
  • 25 Fanua SP, Kim J, Shaw Wilgis EF. Alternative model for teaching microsurgery. Microsurgery 2001; 21 (08) 379-382
    CrossrefPubMedGoogle Scholar
  • 26 Crosby NL, Clapson JB, Buncke HJ, Newlin L. Advanced non-animal microsurgical exercises. Microsurgery 1995; 16 (09) 655-658
    CrossrefPubMedGoogle Scholar
  • 27 Matsumura N, Horie Y, Shibata T, Kubo M, Hayashi N, Endo S. Basic training model for supermicrosurgery: a novel practice card model. J Reconstr Microsurg 2011; 27 (06) 377-382
    Article in Thieme ConnectPubMedGoogle Scholar
  • 28 Schoffl H, Hager D, Hinterdorfer C. , et al. Pulsatile perfused porcine coronary arteries for microvascular training. Ann Plast Surg 2006; 57 (02) 213-216
    CrossrefPubMedGoogle Scholar
  • 29 Hwang G, Oh CW, Park SQ, Sheen SH, Bang JS, Kang HS. Comparison of different microanastomosis training models: model accuracy and practicality. J Korean Neurosurg Soc 2010; 47 (04) 287-290
    CrossrefPubMedGoogle Scholar
  • 30 Huang GK, Hu RQ, Pan GP. Influence of vessel clips on vascular patency in microarterial grafts less than 0.5 mm in external diameter. J Hand Surg Am 1985; 10 (04) 538-541
    CrossrefPubMedGoogle Scholar
  • 31 Sakrak T, Köse AA, Karabağli Y, Koçman AE, Ozbayoğlu AC, Cetįn C. Rat tail revascularization model for advanced microsurgery training and research. J Reconstr Microsurg 2011; 27 (07) 391-396
    Article in Thieme ConnectPubMedGoogle Scholar
  • 32 Yamashita S, Sugiyama N, Hasegawa K, Namba Y, Kimata Y. A novel model for supermicrosurgery training: the superficial inferior epigastric artery flap in rats. J Reconstr Microsurg 2008; 24 (08) 537-543
    Article in Thieme ConnectPubMedGoogle Scholar
  • 33 Liu HL. Microvascular anastomosis of submillimeter vessels-a training model in rats. J Hand Microsurg 2013; 5 (01) 14-17
    Article in Thieme ConnectPubMedGoogle Scholar
  • 34 Narushima M, Koshima I, Mihara M, Uchida G, Gonda K. Intravascular stenting (IVaS) for safe and precise supermicrosurgery. Ann Plast Surg 2008; 60 (01) 41-44
    CrossrefPubMedGoogle Scholar
  • 35 Cooley BC, Daley R. Free flap transplantation in mice. Microsurgery 1998; 18 (05) 320-323
    CrossrefPubMedGoogle Scholar
  • 36 Akyürek M, Safak T, Oztekin C, Sargon M, Keçik A. Dorsal penile vein as a new training model for microvenous anastomosis in rats. Ann Plast Surg 2002; 49 (03) 280-284
    CrossrefPubMedGoogle Scholar
  • 37 Koshima I, Nanba Y, Tsutsui T, Takahashi Y. Medial plantar perforator flaps with supermicrosurgery. Clin Plast Surg 2003; 30 (03) 447-455 , vii
    CrossrefPubMedGoogle Scholar
  • 38 Pruthi N, Sarma P, Pandey P. Training in micro-vascular anastomosis using rat femoral vessels: comparison of immediate and delayed patency rates. Turk Neurosurg 2016; DOI: 10.5137/1019-5149.
    CrossrefPubMedGoogle Scholar
  • 39 Margovsky AI, Chambers AJ, Lord RS. The effect of increasing clamping forces on endothelial and arterial wall damage: an experimental study in the sheep. Cardiovasc Surg 1999; 7 (04) 457-463
    CrossrefPubMedGoogle Scholar
  • 40 Saba D, Yilmaz M, Yavuz H. , et al. Sutureless vascular anastomoses by N-butyl-2 cyanoacrylate adhesive: an experimental animal study. Eur Surg Res 2007; 39 (04) 239-244
    CrossrefPubMedGoogle Scholar
  • 41 Siemionow M. Evaluation of long-term patency rates of different techniques of arterial anastomosis in rabbits. Microsurgery 1987; 8 (01) 25-29
    CrossrefPubMedGoogle Scholar
  • 42 Lidman D, Lyczakowski T, Daniel RK. The morphology and patency of arterial and venous microvascular anastomoses throughout the first post-operative year. A histological study. Scand J Plast Reconstr Surg 1984; 18 (02) 187-192
    CrossrefPubMedGoogle Scholar
  • 43 Camilleri J, Berry C, Fiessinger J-N, Bariety Jeds. Perioperative arterial changes. Pathology of the operated artery due to inclusion of a foreign body in the wall of the artery. In: Diseases of the Arterial Wall. 1st ed. London: Springer-Verlag; 1989: 693
    Google Scholar