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Tran DL, Cassidy MF, Chinta SR, Shah AR, Huang RW, Rodriguez ED, Ceradini DJ. Novel Osteomyocutaneous Flap Model for Vascularized Composite Allotransplantation. JPRAS Open 2024; 41:244-251. [PMID: 39099676 PMCID: PMC11295284 DOI: 10.1016/j.jpra.2024.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 05/16/2024] [Indexed: 08/06/2024] Open
Abstract
Background Vascularized composite allotransplantation (VCA) has become a viable option for restoration of devastating injuries that are not amenable to conventional reconstructive techniques. However, the relative scarcity of procedures performed worldwide, as well as the potential for iatrogenic injury with biopsies, makes studying the immunopathogenesis of acute rejection challenging. Translational VCA research focuses on developing strategies to overcome these barriers with the use of animal models can be technically challenging and difficult to replicate without highly trained microsurgeons. Methods We describe a modified model of a femur-based composite tissue allograft using an adapted vascular cuff anastomotic technique with a tunneled skin flap in a rodent model. Results The use of a heterotopic osteomyocutaneous flap with a subcutaneously tunneled-skin paddle to the posterolateral aspect of the recipient rodent allows for ease of flap monitoring and reduces the risk of self-mutilation. A total of six transplantations were conducted with no signs of self-mutilation. Operative time decreased as our surgical technique improved, and long-term graft tolerance was possible under our immunosuppressive regimen. Additionally, we demonstrate cases of successful transplantation in both an allogeneic and syngeneic rodent model. Conclusion Animal models, although technically challenging, are a reliable and reproducible modality that has been used to investigate various aspects of VCA immunology. We describe the success of an osteomyocutaneous flap with a modified vascular cuff anastomosis that can be used by investigators with less experience in microsurgical techniques to further our understanding of VCA physiology. Furthermore, tunneling of the skin paddle reduces the risk of self-mutilation and other external factors affecting the graft.
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Affiliation(s)
- David L. Tran
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York
| | - Michael F. Cassidy
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York
| | - Sachin R. Chinta
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York
| | - Alay R. Shah
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York
| | - Ren-Wen Huang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taiwan
| | - Eduardo D. Rodriguez
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York
| | - Daniel J. Ceradini
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York
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Kocaaga B, Inan T, Yasar Nİ, Yalcin CE, Sungur FA, Kurkcuoglu O, Demiroz A, Komurcu H, Kizilkilic O, Aydin SY, Aydin Ulgen O, Güner FS, Arslan H. Innovative Use of an Injectable, Self-Healing Drug-Loaded Pectin-Based Hydrogel for Micro- and Supermicro-Vascular Anastomoses. Biomacromolecules 2024; 25:3959-3975. [PMID: 38934558 PMCID: PMC11238333 DOI: 10.1021/acs.biomac.4c00102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
Microvascular surgery plays a crucial role in reconnecting micrometer-scale vessel ends. Suturing remains the gold standard technique for small vessels; however, suturing the collapsed lumen of microvessels is challenging and time-consuming, with the risk of misplaced sutures leading to failure. Although multiple solutions have been reported, the emphasis has predominantly been on resolving challenges related to arteries rather than veins, and none has proven superior. In this study, we introduce an innovative solution to address these challenges through the development of an injectable lidocaine-loaded pectin hydrogel by using computational and experimental methods. To understand the extent of interactions between the drug and the pectin chain, molecular dynamics (MD) simulations and quantum mechanics (QM) calculations were conducted in the first step of the research. Then, a series of experimental studies were designed to prepare lidocaine-loaded injectable pectin-based hydrogels, and their characterization was performed by using Fourier transform infrared spectroscopy (FT-IR), scanning electron microscopy (SEM), and rheological analysis. After all the results were evaluated, the drug-loaded pectin-based hydrogel exhibiting self-healing properties was selected as a potential candidate for in vivo studies to determine its performance during operation. In this context, the hydrogel was injected into the divided vessel ends and perivascular area, allowing for direct suturing through the gel matrix. While our hydrogel effectively prevented vasospasm and facilitated micro- and supermicro-vascular anastomoses, it was noted that it did not cause significant changes in late-stage imaging and histopathological analysis up to 6 months. We strongly believe that pectin-based hydrogel potentially enhanced microlevel arterial, lymphatic, and particularly venous anastomoses.
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Affiliation(s)
- Banu Kocaaga
- Department of Chemical Engineering, Istanbul Technical University, Maslak, 34469 Istanbul, Turkey
| | - Tugce Inan
- Department of Chemical Engineering, Istanbul Technical University, Maslak, 34469 Istanbul, Turkey
| | - Nesrin İsil Yasar
- Informatics Institute, Computational Science and Engineering Division, Istanbul Technical University, Maslak, 34469 Istanbul, Turkey
| | - Can Ege Yalcin
- Cerrahpasa Medical Faculty, Department of Plastic, Reconstructive and Aesthetic Surgery, Istanbul University-Cerrahpasa, Istanbul 34089, Turkey
| | - Fethiye Aylin Sungur
- Informatics Institute, Computational Science and Engineering Division, Istanbul Technical University, Maslak, 34469 Istanbul, Turkey
| | - Ozge Kurkcuoglu
- Department of Chemical Engineering, Istanbul Technical University, Maslak, 34469 Istanbul, Turkey
| | - Anil Demiroz
- Cerrahpasa Medical Faculty, Department of Plastic, Reconstructive and Aesthetic Surgery, Istanbul University-Cerrahpasa, Istanbul 34089, Turkey
| | - Hasan Komurcu
- Department of Plastic, Reconstructive and Aesthetic Surgery, Balat Or-Ahayim Hastanesi, Istanbul 34087, Turkey
| | - Osman Kizilkilic
- Cerrahpasa Medical Faculty, Department of Interventional Radiology, Istanbul University-Cerrahpasa, Istanbul 34098, Turkey
| | - Servet Yekta Aydin
- Cerrahpasa Medical Faculty, Department of Plastic, Reconstructive and Aesthetic Surgery, Istanbul University-Cerrahpasa, Istanbul 34089, Turkey
| | - Ovgu Aydin Ulgen
- Cerrahpasa Medical Faculty, Department of Pathology, Istanbul University-Cerrahpasa, Istanbul 34098, Turkey
| | - Fatma Seniha Güner
- Department of Chemical Engineering, Istanbul Technical University, Maslak, 34469 Istanbul, Turkey
- Sabancı University Nanotechnology Research and Application Center, Istanbul 34956, Turkey
| | - Hakan Arslan
- Cerrahpasa Medical Faculty, Department of Plastic, Reconstructive and Aesthetic Surgery, Istanbul University-Cerrahpasa, Istanbul 34089, Turkey
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Orădan AV, Dindelegan GC, Vinaşi RC, Muntean MV, Dindelegan MG, Chiriac L, Volovici V. Reduction of Anastomotic Time Through the Use of Cyanoacrylate in Microvascular Procedures. Plast Surg (Oakv) 2022; 30:335-342. [PMID: 36212098 PMCID: PMC9537713 DOI: 10.1177/22925503211019619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 04/16/2021] [Indexed: 11/03/2023] Open
Abstract
Background: Ever since the description of the first microvascular anastomosis, numerous alternative methods have been described to the classical approach. Tissue adhesive has shown promising result in previous studies and can be a fast and efficient alternative which still requires more studies to allow its clinical implementation. Methods: A randomized comparative experimental study was conducted on rats' femoral arteries and an end-to-end anastomosis was performed in order to compare 2 anastomosis techniques. In one group, a simple interrupted suture was utilized, whereas in the second group a combination between fewer sutures and tissue adhesive was used. The anastomotic time, total operative time, blood flow velocity before, immediately after and 48 hours after the procedure, as well as an independent grading of the anastomosis immediately after the procedure were performed. Magnetic resonance imaging (MRI) was performed in order to assess the degree of stenosis. After euthanasia, histology and scanning electron microscopy (SEM) were performed on the vessels in order to assess possible complications. Results: A total of 24 anastomoses were performed, of which 12 with a classic technique and 12 with an adhesive technique. All the anastomoses were patent with a significant reduction of anastomotic and total operative time. The grading of the anastomoses showed better results in the classic suture group. The blood flow velocities were not statistically significant between the 2 groups. On MRI there was one stenotic anastomosis, whereas histology and SEM showed more complications on the adhesive group. Conclusion: Anastomotic times were significantly lower with a non-significant trend toward more thrombotic complications in the adhesive group. Further improvement of the glue properties and refinement of the technique will likely make it a viable alternative to interrupted suturing in the future.
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Affiliation(s)
- Alex V. Orădan
- Department of Plastic Surgery, Clinical Rehabilitation
Hospital, “Iuliu Haţieganu” University of
Medicine and Pharmacy, Cluj-Napoca, Romania
- Center for Surgical Simulation and Training, “Iuliu Haţieganu” University of
Medicine and Pharmacy, Cluj-Napoca, Romania
| | - George C. Dindelegan
- Center for Surgical Simulation and Training, “Iuliu Haţieganu” University of
Medicine and Pharmacy, Cluj-Napoca, Romania
- First Surgical Clinic, “Iuliu Haţieganu” University of
Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ramona C. Vinaşi
- Center for Surgical Simulation and Training, “Iuliu Haţieganu” University of
Medicine and Pharmacy, Cluj-Napoca, Romania
- Department of Neuroscience, “Iuliu Haţieganu” University of
Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Maximilian V. Muntean
- Department of Plastic Surgery, “Prof. Dr. I. Chiricuta”
Institute of Oncology, “Iuliu Hatieganu” University of Medicine and
Pharmacy, Cluj-Napoca, Romania
| | - Maximilian G. Dindelegan
- Center for Surgical Simulation and Training, “Iuliu Haţieganu” University of
Medicine and Pharmacy, Cluj-Napoca, Romania
- Department of Otorhinolaryngology, “Iuliu Haţieganu” University of
Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Liviu Chiriac
- National Magnetic Resonance Center, Faculty of Physics,
Babeş-Bolyai University, Cluj Napoca, Romania
| | - Victor Volovici
- Department of Neurosurgery, Erasmus MC University Medical Center, Rotterdam, The
Netherlands
- Center for Medical Decision Making, Department of Public
Health, Erasmus MC University Medical Center, Rotterdam, The
Netherlands
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Cevik J, Hunter-Smith DJ, Rozen WM. Current Advances in Breast Reconstruction. J Clin Med 2022; 11:3328. [PMID: 35743399 PMCID: PMC9224946 DOI: 10.3390/jcm11123328] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 06/08/2022] [Indexed: 01/30/2023] Open
Abstract
Breast cancer management is multidisciplinary, and while oncologic surgery, adjuvant therapy, and psychological therapies are central to this, breast reconstruction also forms an integral part of management [...].
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Affiliation(s)
- Jevan Cevik
- Department of Surgery, Peninsula Clinical School, Central Clinical School, Faculty of Medicine, Monash University, 2 Hastings Road, Frankston, VIC 3199, Australia; (J.C.); (D.J.H.-S.)
- Plastic and Reconstructive Surgery Group, Peninsula Clinical School, Peninsula Health, Monash University, 2 Hastings Road, Frankston, VIC 3199, Australia
| | - David J. Hunter-Smith
- Department of Surgery, Peninsula Clinical School, Central Clinical School, Faculty of Medicine, Monash University, 2 Hastings Road, Frankston, VIC 3199, Australia; (J.C.); (D.J.H.-S.)
- Plastic and Reconstructive Surgery Group, Peninsula Clinical School, Peninsula Health, Monash University, 2 Hastings Road, Frankston, VIC 3199, Australia
| | - Warren M. Rozen
- Department of Surgery, Peninsula Clinical School, Central Clinical School, Faculty of Medicine, Monash University, 2 Hastings Road, Frankston, VIC 3199, Australia; (J.C.); (D.J.H.-S.)
- Plastic and Reconstructive Surgery Group, Peninsula Clinical School, Peninsula Health, Monash University, 2 Hastings Road, Frankston, VIC 3199, Australia
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5
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Wang AYL, Shen HH, Lo WH, Yu WL, Liu YL, Lee CM, Loh CYY. A novel microsurgery clamp incorporating the cuff technique for ultrasmall vessel coaptation. J Plast Reconstr Aesthet Surg 2021; 74:3443-3476. [PMID: 34697004 DOI: 10.1016/j.bjps.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 03/26/2021] [Accepted: 09/19/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Aline Yen Ling Wang
- Center for Vascularized Composite Allotransplantation, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsin-Hsin Shen
- Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Hsinchu, Taiwan
| | - Wan-Hsun Lo
- Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Hsinchu, Taiwan
| | - Wei-Lin Yu
- Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Hsinchu, Taiwan
| | - Yung-Lung Liu
- Mechanical and Mechatronics Systems Research Labs, Industrial Technology Research Institute, Hsinchu, Taiwan
| | - Chin-Ming Lee
- Center for Vascularized Composite Allotransplantation, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Charles Yuen Yung Loh
- Plastic and Reconstructive Surgery, Addenbrooke's Hospital, Cambridge University Hospitals, Hills Road, Cambridge, CB2 0QQ, UK.
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Hand-sewn, coupler and Doppler-assisted venous anastomosis in free flap surgery: a systematic review and meta-analysis. EUROPEAN JOURNAL OF PLASTIC SURGERY 2021. [DOI: 10.1007/s00238-021-01854-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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7
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Maruccia M, Fatigato G, Elia R, Ragusa LA, Vestita MG, Nacchiero E, Robusto F, Nicoli F, Pedro Ciudad, Giudice G. Microvascular coupler device versus hand-sewn venous anastomosis: A systematic review of the literature and data meta-analysis. Microsurgery 2020; 40:608-617. [PMID: 32246807 DOI: 10.1002/micr.30585] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 01/22/2020] [Accepted: 03/20/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Successful vascular anastomosis is essential for the survival of free tissue transfer. The aim of the study is to review the current literature and perform a meta-analysis to assess the potential advantages of a mechanical anastomosis coupler device (MACD) over the hand-sewn (HS) technique for venous anastomoses. METHODS A systematic Medline search was performed to gather all reports of articles related to MACD from 1984 until now. The following data were extracted: first author and publication date, study design, number of patients and anastomosis, coupler size, site and type of reconstruction, venous anastomotic time, flap failure. A meta-analysis was performed on articles that met the following inclusion criteria: studies comparing MACD and HS technique in venous anastomosis, reporting anastomotic time, and postoperative complications. RESULTS Thirty-three studies were included for the analysis. Twenty-four were retrospective case series and nine were retrospective comparative studies. A total of 12,304 patients were enrolled with a mean age of 49.23 years (range 31-72). A total of 13,669 flaps were accomplished. The thrombosis rate recorded with MACD was 1.47%. The meta-analysis revealed that MACD significantly decreased anastomotic time (standard difference in means = -0.395 ± 0.105; Z = -3.776; p < .001) and postoperative flap failure risk (odds ratio [OR] = 0.362, 95% confidence interval [CI] = 0.218-0.603, Z = -3.908, p < .001), but it did not decrease postoperative venous thrombosis risk (OR = 0.504, 95% CI = 0.255-1.129, Z = -1.666, p = .096). CONCLUSIONS MACDs are a safe and effective alternative to traditional anastomosis. The anastomotic coupler is easier, much faster, and requires less technical skills than a HS microvascular anastomosis.
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Affiliation(s)
- Michele Maruccia
- Section of Plastic and Reconstructive Surgery, Department of Emergency and Organ transplantation, University of Bari, Bari, Italy
| | - Giusy Fatigato
- Section of Plastic and Reconstructive Surgery, Department of Emergency and Organ transplantation, University of Bari, Bari, Italy
| | - Rossella Elia
- Section of Plastic and Reconstructive Surgery, Department of Emergency and Organ transplantation, University of Bari, Bari, Italy
| | - Luigi Amerigo Ragusa
- Section of Plastic and Reconstructive Surgery, Department of Emergency and Organ transplantation, University of Bari, Bari, Italy
| | - Michelangelo G Vestita
- Section of Plastic and Reconstructive Surgery, Department of Emergency and Organ transplantation, University of Bari, Bari, Italy
| | - Eleonora Nacchiero
- Section of Plastic and Reconstructive Surgery, Department of Emergency and Organ transplantation, University of Bari, Bari, Italy
| | - Fabio Robusto
- Section of Plastic and Reconstructive Surgery, Department of Emergency and Organ transplantation, University of Bari, Bari, Italy
| | - Fabio Nicoli
- Department of Plastic and Reconstructive Surgery, Royal Victoria Infirmary Hospital Newcastle NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Pedro Ciudad
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Giuseppe Giudice
- Section of Plastic and Reconstructive Surgery, Department of Emergency and Organ transplantation, University of Bari, Bari, Italy
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8
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Clinical Feasibility of Large Gastrotomy Closure Using a Flexible Tissue Glue Based on N-Butyl-2-Cyanoacrylate: Experimental Study in Pigs. J Gastrointest Surg 2019; 23:247-255. [PMID: 30097967 DOI: 10.1007/s11605-018-3910-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 07/31/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND The use of synthetic adhesives such as cyanoacrylates has been established previously for a wide range of clinical indications. However, more research is necessary to evaluate their use in digestive closures or anastomosis. New chemical formulations developed to achieve more flexibility of synthetic adhesives (i.e., based on n-butyl-2-cyanoacrylate) could be an alternative to achieve this purpose. The aim of this study was to investigate the feasibility of using flexible cyanoacrylate adhesives for large gastric incision closure in an animal model. METHODS Twelve farm pigs were divided in two groups depending on the type of closure method applied. In all cases, extra-large seven centimeters gastrostomies were performed. Braided absorbable hand-sewn interrupted suture versus n-butyl-2-cyanoacrylate with softener closure were compared during a 3-week follow-up period. Histopathological aspects, hematologic and inflammatory biomarkers, and endoluminal pressure tolerated until leakage were assessed. The time spent on both closing procedures was compared. RESULTS No differences between the two groups were found in any of the histopathological and inflammatory variables evaluated. The glued group tolerated a significantly higher pressure than the manual suture group. A reduction of surgery time was also observed. CONCLUSIONS Our results suggest that flexible cyanoacrylates could be a feasible alternative to improve the clinical outcome of the closure of hollow viscera through more efficient sutureless procedures.
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9
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Rodi T, Geierlehner A, Mosahebi A, Tanos G, Wormald JCR. Protocol for a systematic review of venous coupler devices versus hand-sewn anastomosis for microsurgical free flap reconstruction. Syst Rev 2018; 7:186. [PMID: 30424802 PMCID: PMC6234594 DOI: 10.1186/s13643-018-0871-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 11/02/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND A patent microvascular anastomosis is of paramount importance in free tissue transfer. Anastomotic coupler devices provide an alternative to technically demanding hand-sewn venous anastomosis. Various advantages of these devices have been discussed but previous systematic reviews had methodological flaws or did not perform a meta-analysis. This review aims to evaluate the quality of the evidence and quantify the efficacy and safety of venous couplers compared to hand-sewn anastomosis. METHODS A PRISMA-compliant systematic review and meta-analysis will be performed. A comprehensive search strategy has been developed and will be applied to the databases MEDLINE and Embase from inception to October 2018. All clinical studies using anastomotic coupler devices for venous anastomoses in free tissue transfer will be eligible for inclusion. Screening of studies and data extraction will be performed independently by two authors. Our primary outcome is anastomotic venous thrombosis. Secondary outcomes will include time to complete the venous anastomosis, tearing of veins, anastomotic leakage, flap loss/failure and fiscal outcomes. The risk of bias for included studies will be assessed by using the ROBINS-I tool, and recommendations based on the evidence will be made using the GRADE approach. Descriptive statistical analyses will be used and if two or more studies report the same outcome, data will be pooled for comparative analysis. A direct comparison meta-analysis will be performed if possible. DISCUSSION There has been no comparison of coupled and hand-sewn venous anastomoses using a robust and validated methodology preceded by a protocol and performing meta-analysis. Included studies are expected to be mainly observational and prone to bias; however, there is value in summarising the evidence, assessing its risk of bias and performing meta-analysis to guide clinicians. By using a broad approach including all types of flaps, we foresee inherent differences regarding the unit of analysis and different anatomic sites. This will limit the validity of our conclusions but is unavoidable. We will seek unpublished data from authors and perform subgroup analysis where appropriate. Limitations and areas of uncertainty will be discussed to guide future research. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018110111.
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Affiliation(s)
- Timo Rodi
- UCL Division of Surgery and Interventional Science, Royal Free Hospital, 9th Floor, Pond Street, London, NW3 2QG UK
| | - Alexander Geierlehner
- UCL Division of Surgery and Interventional Science, Royal Free Hospital, 9th Floor, Pond Street, London, NW3 2QG UK
| | - Afshin Mosahebi
- UCL Division of Surgery and Interventional Science, Royal Free Hospital, 9th Floor, Pond Street, London, NW3 2QG UK
- Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK
| | - Grigorios Tanos
- Department of Plastic Surgery, Stoke Mandeville Hospital, Aylesbury, Buckinghamshire UK
| | - Justin Conrad Rosen Wormald
- Department of Plastic Surgery, Stoke Mandeville Hospital, Aylesbury, Buckinghamshire UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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10
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Mechanical versus Hand-Sewn Venous Anastomoses in Free Flap Reconstruction. Plast Reconstr Surg 2018; 141:1272-1281. [DOI: 10.1097/prs.0000000000004306] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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11
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Julián Ibáñez JF, Tarascó Palomares J, Navinés López J, Balibrea Del Castillo JM, Odermatt EK, Pacha González MA, Del Castillo Riestra LF, Guardia Torner N, Turon Dols P, Fernández-Llamazares Rodríguez J. Introduction of Flexible Cyanoacrylates in Sutureless Gastric Closure. Surg Innov 2016; 23:490-7. [PMID: 26994217 DOI: 10.1177/1553350616639142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Clinical effectiveness and safety of biological and synthetic adhesives in digestive closures have been evaluated. Their use is becoming more prevalent, as rigidity and inflexibility are its more remarkable weaknesses. However, little is known about their role in gastric and anastomotic closures. Moreover, usefulness of novel flexible types of synthetic adhesives as n-butyl-cyanoacrylate has not been assessed yet. Materials and Methods One centimeter long gastrotomy was performed in 24 male Wistar rats, which were divided depending on the type of closure method employed: manual USP 5/0 silk interrupted suture versus sutureless closure with Histoacryl Flexible (n-butyl-cyanoacrylate with softener) or Histoacryl Double Component (n-butyl-cyanoacrylate with softener and hardener). Microscopic evaluation of the suture viability and integrity was performed, and adhesion formation during the cicatrization process were assessed. During an 8-week follow-up clinical and histopathological aspects as well as hematologic and inflammatory biomarkers were studied. Results No differences among groups where found in any of the clinical, analytical, or histopathological issues assessed except for a higher incidence rate of adhesions in the Histoacryl Double Component group when compared with hand-sewn suture group (P = .04). Our results support experimental studies in large mammals (pigs) for further study of sutureless hollow viscera closure.
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Affiliation(s)
- Joan F Julián Ibáñez
- Germans Trias I Pujol Hospital, Universitat Autònoma de Barcelona, Badalona (Barcelona), Spain
| | - Jordi Tarascó Palomares
- Germans Trias I Pujol Hospital, Universitat Autònoma de Barcelona, Badalona (Barcelona), Spain
| | - Jordi Navinés López
- Germans Trias I Pujol Hospital, Universitat Autònoma de Barcelona, Badalona (Barcelona), Spain
| | | | | | - Miguel A Pacha González
- Germans Trias I Pujol Hospital, Universitat Autònoma de Barcelona, Badalona (Barcelona), Spain
| | | | - Natàlia Guardia Torner
- Germans Trias I Pujol Hospital, Universitat Autònoma de Barcelona, Badalona (Barcelona), Spain
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Risk of Thromboembolus after Application of Different Tissue Glues during Microvascular Anastomosis. Plast Reconstr Surg 2016; 136:1216-1225. [PMID: 26267401 DOI: 10.1097/prs.0000000000001808] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Tissue glues are a useful tool for hemostasis and a potential tool for microvascular anastomosis. The hemostatic power and thrombotic risk of these surgical aids have been the subject of debate, but studies regarding thromboembolic risks of tissue glues are lacking. METHODS The authors compared the thromboembolic risk of three different tissue glues (six interrupted sutures complemented with fibrin, FloSeal, or TachoSil) against a control group (12 interrupted sutures) in the aorta-filter model in the rat. Each group consisted of 10 rats, examined 4 hours and 14 days postoperatively (total n = 80) using a structured protocol to assess the patency and condition of the filter, amount of thromboembolic material, and histologic appearance of the vessel wall. RESULTS In total, 160 anastomoses were performed in 80 rats. The overall patency rate for the groups was 90 percent (control), 35 percent (fibrin glue), 25 percent (FloSeal), and 10 percent (TachoSil). All experimental groups had significantly faster mean anastomotic times and less blood loss compared with the control group. Patency rates were reduced and thromboembolic material was significantly increased in all experimental groups. Histologically, the use of tissue glue reduced the incidence of irritation of the internal elastic lamina and was associated with an increased incidence of fibrocyte infiltration of the media, hypercellularity of the adventitia, and adventitial neovascularization and lymphangiogenesis. CONCLUSION The application of tissue glues in microvascular anastomosis reduces the time needed for anastomosis but was associated with a statistically significant increase in thromboembolism.
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Langer S, Schildhauer TA, Dudda M, Sauber J, Spindler N. Fibrin glue as a protective tool for microanastomoses in limb reconstructive surgery. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2016; 4:Doc14. [PMID: 26759762 PMCID: PMC4709928 DOI: 10.3205/iprs000073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Aim: Fibrin glue becomes a more and more routinely used tool for stabilization of microanastomoses and nerve repair. This paper summarizes the technical properties and advantages of its use in a wide variety of microsurgical contexts, and includes an exemplary limb reconstructive case. Patients and methods: A total of 131 patients who had undergone elective and emergency microsurgery mainly of the limbs were retrospectively analyzed, as was the use of free flaps. Results: The use of fibrin glue allows for proper positioning of anastomoses and repaired nerves. No torsion of the pedicle could be seen. The flap survival rated >94%. The fibrin glue could stay in place in >99%. In the rare case of revision, the fibrin glue could easily be removed without damaging the region of the microanastomosis. Conclusion: Fibrin glue should not be used to repair insufficient, i.e., leaking anastomoses, but it does protect the site of anastomosis from tissue and fluid pressure. It prevents the pedickle from torsion and its use facilitates relocation of the microanastomoses in cases of revision surgery.
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Affiliation(s)
- Stefan Langer
- Department of Plastic, Esthetic and Special Hand Surgery, University Hospital Leipzig, Germany
| | - Thomas A Schildhauer
- Department of Trauma, University Hospital Bergmannsheil, Ruhr University Bochum, Germany
| | - Marcel Dudda
- Department of Trauma, University Hospital Bergmannsheil, Ruhr University Bochum, Germany
| | - Jeannine Sauber
- Department of Plastic, Esthetic and Special Hand Surgery, University Hospital Leipzig, Germany
| | - Nick Spindler
- Department of Plastic, Esthetic and Special Hand Surgery, University Hospital Leipzig, Germany
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Smith DJ, Brat GA, Medina SH, Tong D, Huang Y, Grahammer J, Furtmüller GJ, Oh BC, Nagy-Smith KJ, Walczak P, Brandacher G, Schneider. JP. A multiphase transitioning peptide hydrogel for suturing ultrasmall vessels. NATURE NANOTECHNOLOGY 2016; 11:95-102. [PMID: 26524396 PMCID: PMC4706483 DOI: 10.1038/nnano.2015.238] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 09/08/2015] [Indexed: 05/21/2023]
Abstract
Many surgeries are complicated by the need to anastomose, or reconnect, micrometre-scale vessels. Although suturing remains the gold standard for anastomosing vessels, it is difficult to place sutures correctly through collapsed lumen, making the procedure prone to failure. Here, we report a multiphase transitioning peptide hydrogel that can be injected into the lumen of vessels to facilitate suturing. The peptide, which contains a photocaged glutamic acid, forms a solid-like gel in a syringe and can be shear-thin delivered to the lumen of collapsed vessels (where it distends the vessel) and the space between two vessels (where it is used to approximate the vessel ends). Suturing is performed directly through the gel. Light is used to initiate the final gel-sol phase transition that disrupts the hydrogel network, allowing the gel to be removed and blood flow to resume. This gel adds a new tool to the armamentarium for micro- and supermicrosurgical procedures.
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Affiliation(s)
- Daniel J. Smith
- National Cancer Institute, Chemical Biology Laboratory, Frederick, MD 21702 USA
- Department of Chemistry and Biochemistry, University of Delaware, Newark, DE 19716 USA
| | - Gabriel A. Brat
- Johns Hopkins University School of Medicine, Department of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation (VCA) Laboratory, Baltimore, Maryland 21287 USA
| | - Scott H. Medina
- National Cancer Institute, Chemical Biology Laboratory, Frederick, MD 21702 USA
| | - Dedi Tong
- Johns Hopkins University School of Medicine, Department of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation (VCA) Laboratory, Baltimore, Maryland 21287 USA
| | - Yong Huang
- Johns Hopkins University, Department of Electrical and Computer Engineering, Baltimore, Maryland 21218 USA
| | - Johanna Grahammer
- Johns Hopkins University School of Medicine, Department of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation (VCA) Laboratory, Baltimore, Maryland 21287 USA
| | - Georg J. Furtmüller
- Johns Hopkins University School of Medicine, Department of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation (VCA) Laboratory, Baltimore, Maryland 21287 USA
| | - Byoung Chol Oh
- Johns Hopkins University School of Medicine, Department of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation (VCA) Laboratory, Baltimore, Maryland 21287 USA
| | - Katelyn J. Nagy-Smith
- National Cancer Institute, Chemical Biology Laboratory, Frederick, MD 21702 USA
- Department of Chemistry and Biochemistry, University of Delaware, Newark, DE 19716 USA
| | - Piotr Walczak
- Johns Hopkins University School of Medicine, Department of Radiology and Radiological Science, Baltimore, Maryland 21287 USA
| | - Gerald Brandacher
- Johns Hopkins University School of Medicine, Department of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation (VCA) Laboratory, Baltimore, Maryland 21287 USA
| | - Joel P. Schneider.
- National Cancer Institute, Chemical Biology Laboratory, Frederick, MD 21702 USA
- Corresponding author, Tel: 301 846 5954,
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Qassemyar Q, Michel G. A new method of sutureless microvascular anastomoses using a thermosensitive poloxamer and cyanoacrylate: An experimental study. Microsurgery 2015; 35:315-9. [DOI: 10.1002/micr.22381] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 12/28/2014] [Accepted: 12/31/2014] [Indexed: 01/06/2023]
Affiliation(s)
- Q. Qassemyar
- Division of Plastic and Reconstructive Surgery; Gustave Roussy Cancer Campus; Grand Paris, 114 Rue Edouard Vaillant Villejuif France
- Department of Anatomy; University of Picardie; Rue Des Louvels Amiens France
| | - G. Michel
- Department of Anatomy; University of Picardie; Rue Des Louvels Amiens France
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Jose RR, Raja WK, Ibrahim AMS, Koolen PGL, Kim K, Abdurrob A, Kluge JA, Lin SJ, Beamer G, Kaplan DL. Rapid prototyped sutureless anastomosis device from self-curing silk bio-ink. J Biomed Mater Res B Appl Biomater 2014; 103:1333-43. [PMID: 25385518 DOI: 10.1002/jbm.b.33312] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 08/28/2014] [Accepted: 10/10/2014] [Indexed: 01/03/2023]
Abstract
Sutureless anastomosis devices are designed to reduce surgical time and difficulty, which may lead to quicker and less invasive cardiovascular anastomosis. The implant uses a barb-and-seat compression fitting composed of one male and two female components. The implant body is resorbable and capable of eluting heparin. Custom robotic deposition equipment was designed to fabricate the implants from a self-curing silk solution. Curing did not require deleterious processing steps but devices demonstrated high crush resistance, retention strength, and leak resistance. Radial crush resistance is in the range of metal vascular implants. Insertion force and retention strength of the anastomosis was dependent on fit sizing of the male and female components and subsequent vessel wall compression. Anastomotic burst strength was dependent on the amount of vessel wall compression, and capable of maintaining higher than physiological pressures. In initial screening using a porcine implant, the devices remained intact for 28 days (the length of study). Histological sections revealed cellular infiltration within the laminar structure of the male component, as well as at the interface between the male and female components. Initial degradation and absorption of the implant wall were observed. The speed per anastomosis using this new device was much faster than current systems, providing significant clinical improvement.
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Affiliation(s)
- Rod R Jose
- Department of Biomedical Engineering, Science and Technology Center, Tufts University, Medford, Massachusetts, 02155
| | - Waseem K Raja
- Department of Biomedical Engineering, Science and Technology Center, Tufts University, Medford, Massachusetts, 02155
| | - Ahmed M S Ibrahim
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, 02215
| | - Pieter G L Koolen
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, 02215
| | - Kuylhee Kim
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, 02215
| | - Abdurrahman Abdurrob
- Department of Biomedical Engineering, Science and Technology Center, Tufts University, Medford, Massachusetts, 02155
| | - Jonathan A Kluge
- Department of Biomedical Engineering, Science and Technology Center, Tufts University, Medford, Massachusetts, 02155
| | - Samuel J Lin
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, 02215
| | - Gillian Beamer
- Department of Infectious Disease and Global Health, Cummings School of Veterinary Medicine, Tufts Clinical and Translational Science Institute, Tufts University, Grafton, MA 01536
| | - David L Kaplan
- Department of Biomedical Engineering, Science and Technology Center, Tufts University, Medford, Massachusetts, 02155
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Fibrin Sealant: The Only Approved Hemostat, Sealant, and Adhesive-a Laboratory and Clinical Perspective. ISRN SURGERY 2014; 2014:203943. [PMID: 24729902 PMCID: PMC3960746 DOI: 10.1155/2014/203943] [Citation(s) in RCA: 200] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 11/18/2013] [Indexed: 02/07/2023]
Abstract
Background. Fibrin sealant became the first modern era material approved as a hemostat in the United States in 1998. It is the only agent presently approved as a hemostat, sealant, and adhesive by the Food and Drug Administration (FDA). The product is now supplied as patches in addition to the original liquid formulations. Both laboratory and clinical uses of fibrin sealant continue to grow. The new literature on this material also continues to proliferate rapidly (approximately 200 papers/year). Methods. An overview of current fibrin sealant products and their approved uses and a comprehensive PubMed based review of the recent literature (February 2012, through March 2013) on the laboratory and clinical use of fibrin sealant are provided. Product information is organized into sections based on a classification system for commercially available materials. Publications are presented in sections based on both laboratory research and clinical topics are listed in order of decreasing frequency. Results. Fibrin sealant remains useful hemostat, sealant, and adhesive. New formulations and applications continue to be developed. Conclusions. This agent remains clinically important with the recent introduction of new commercially available products. Fibrin sealant has multiple new uses that should result in further improvements in patient care.
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Schmitt T, Talley J, Chang J. New Concepts and Technologies in Reconstructive Hand Surgery. Clin Plast Surg 2012; 39:445-51. [DOI: 10.1016/j.cps.2012.07.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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20
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A three-dimensional stereoscopic monitor system in microscopic vascular anastomosis. Microsurgery 2012; 32:571-4. [DOI: 10.1002/micr.22035] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 04/30/2012] [Indexed: 11/07/2022]
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