Research Article
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Folded-Stent: Mikrovasküler Stentleme Tekniğini Geliştirmek İçin Üçüncü Nesil Yöntem

Year 2023, Volume: 6 Issue: 1, 107 - 112, 28.02.2023
https://doi.org/10.53446/actamednicomedia.1211765

Abstract

Amaç: Mikrocerrahi damar anastomozları günümüzde rutin bir işlem haline gelmesine rağmen halen uygulanması zor teknikler arasındadır. Tekniğin başarısındaki en önemli adım damar lümeninin net olarak gösterilmesidir. Bu çalışmada mikrovasküler anastomozlarda lümeni açık tutarak daha kolay anastomoz sağlayacak yeni bir tekniği tanımlamayı amaçladık.
Yöntem: Cansız bir hayvan modeli olan tavuk kanadı radial arter kullanılarak dört grup oluşturuldu. Bunlardan biri standart mikrovasküler onarım yapılan kontrol grubuydu. Takip eden ikinci ve üçüncü gruplar, önceden tanımlanmış iki intravasküler stentleme tekniğinin uygulandığı gruplardı. Dördüncü grup ise yeni tanımladığımız Folded stent grubuydu.
Bulgular: Yeni tanımlanan tekniğimizde anastomoz süresi diğer gruplara göre anlamlı olarak daha uzun bulundu. Bu süre ortalama 3 dakikaydı. Anastomozlarda kullanılan sütür sayısı açısından anlamlı bir farklılık gözlenmedi. Hiçbir örnekte arka duvar sütür komplikasyonu gözlenmedi.
Sonuç: “Folded-Stent” tekniği, anastomoz sırasında lümenin açık kalması ve damar duvarlarının yapışmasını önlemesi açısından diğer stentleme tekniklerine göre büyük avantaj sağlamaktadır. Klinik pratikte özellikle venöz onarımlar sırasında küçük çaplı damarların arka duvar dikilmesini önlemek için kullanılabilecek avantajlı bir tekniktir.

References

  • 1. Lorenzo AR. Principles, Techniques and Applications in Microsurgery. Ann Plast Surg. 2009;62(6):600. doi:10.1097 /SAP.0b013e3181a6cb68
  • 2. Kania K, Chang DK, Abu-Ghname A, et al. Microsurgery Training in Plastic Surgery. Plast Reconstr Surg Glob Open. 2020;8(7):e2898. doi:10.1097/GOX.0000000000002898
  • 3. Pafitanis G, Pahal GS, Myers S, Ramakrishnan V. The “Needle-splint” Technique. Plast Reconstr Surg Glob Open. 2020;8(1):e2611. doi:10.1097/GOX.0000000000002611
  • 4. Onoda S, Kimata Y, Goto A. The Drop-Down Technique as an Optimal Technique for Back-Wall End-to-Side Anastomosis. Journal of Craniofacial Surgery. 2014;25(4): 1435-1437. doi:10.1097/SCS.0000000000000754
  • 5. Narushima M, Koshima I, Mihara M, Uchida G, Gonda K. Intravascular Stenting (IVaS) for Safe and Precise Supermicrosurgery. Ann Plast Surg. 2008;60(1):41-44. doi:10.1097/SAP.0b013e3181804bdb38
  • 6. Miyamoto S, Sakuraba M, Asano T, et al. Optimal technique for microvascular anastomosis of very small vessels: Comparative study of three techniques in a rat superficial inferior epigastric arterial flap model. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2010;63(7):1196-1201. doi:10.1016/j.bjps.2009.05.044
  • 7. Schohn T, Lequint T, Naito K, Ramdhian R, Facca S, Liverneaux P. Une astuce pour améliorer la technique du stent intravasculaire (IVaS) : le « Clip Stent ». Annales de Chirurgie Plastique Esthétique. 2011;56(6):512-517. doi:10.1016/j.anplas.2011.09.007
  • 8. Koutsomanis A, Hendriks S, Schohn T, Zemirline A, Liverneaux PA, Facca S. Pull out stent: A trick to improve the intravascular stenting technique. Chir Main. 2014;33(4):251-255. doi:10.1016/j.main.2014.04.004
  • 9. Hong JP (Jp), Song S, Suh HSP. Supermicrosurgery: Principles and applications. J Surg Oncol. 2018;118(5):832-839. doi:10.1002/jso.25243
  • 10. Masia J, Olivares L, Koshima I, et al. Barcelona Consensus on Supermicrosurgery. J Reconstr Microsurg. 2013;30(01): 053-058. doi:10.1055/s-0033-1354742
  • 11. Buncke HJ. Microsurgical research—a personal experience. Microsurgery. 1995;16(4):186-190. doi:10. 1002/micr.1920160405
  • 12. Shurey S, Akelina Y, Legagneux J, Malzone G, Jiga L, Ghanem AM. The Rat Model in Microsurgery Education: Classical Exercises and New Horizons. Arch Plast Surg. 2014;41(03):201-208. doi:10.5999/aps.2014.41.3.201

Folded-Stent: The Third Generation Trick to Improve The Microvascular Stenting Technique

Year 2023, Volume: 6 Issue: 1, 107 - 112, 28.02.2023
https://doi.org/10.53446/actamednicomedia.1211765

Abstract

Objective: Although microsurgical vessel anastomoses have become a routine procedure today, they are still among the difficult techniques to apply. The most important step in the success of the technique is the clear presentation of the vessel lumen. In this study, we aimed to describe a new technique that will provide an easier anastomosis by keeping the lumen open during microvascular anastomoses.
Methods: Four groups were formed using the chicken wing radial artery, which is an inanimate animal model. One of these was the control group who underwent standard microvascular repair. The second and third groups that followed were those in which two previously defined intravascular stenting techniques were applied. The fourth group was the Folded stent group that we just defined.
Results: Anastomosis time was found to be significantly longer when compared to other groups in our newly defined technique. This time was an average of 3 minutes. No significant difference was observed in terms of the number of sutures used in anastomoses. No posterior wall suture complication was observed in any specimen.
Conclusions: “Folded-Stent” technique provides a great advantage over other stenting techniques in terms of keeping the lumen open during the anastomosis and preventing the adhesion of the vessel walls. It is an advantageous technique that can be used in clinical practice, especially during venous repairs, to prevent posterior wall suturing of small caliber vessels.

References

  • 1. Lorenzo AR. Principles, Techniques and Applications in Microsurgery. Ann Plast Surg. 2009;62(6):600. doi:10.1097 /SAP.0b013e3181a6cb68
  • 2. Kania K, Chang DK, Abu-Ghname A, et al. Microsurgery Training in Plastic Surgery. Plast Reconstr Surg Glob Open. 2020;8(7):e2898. doi:10.1097/GOX.0000000000002898
  • 3. Pafitanis G, Pahal GS, Myers S, Ramakrishnan V. The “Needle-splint” Technique. Plast Reconstr Surg Glob Open. 2020;8(1):e2611. doi:10.1097/GOX.0000000000002611
  • 4. Onoda S, Kimata Y, Goto A. The Drop-Down Technique as an Optimal Technique for Back-Wall End-to-Side Anastomosis. Journal of Craniofacial Surgery. 2014;25(4): 1435-1437. doi:10.1097/SCS.0000000000000754
  • 5. Narushima M, Koshima I, Mihara M, Uchida G, Gonda K. Intravascular Stenting (IVaS) for Safe and Precise Supermicrosurgery. Ann Plast Surg. 2008;60(1):41-44. doi:10.1097/SAP.0b013e3181804bdb38
  • 6. Miyamoto S, Sakuraba M, Asano T, et al. Optimal technique for microvascular anastomosis of very small vessels: Comparative study of three techniques in a rat superficial inferior epigastric arterial flap model. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2010;63(7):1196-1201. doi:10.1016/j.bjps.2009.05.044
  • 7. Schohn T, Lequint T, Naito K, Ramdhian R, Facca S, Liverneaux P. Une astuce pour améliorer la technique du stent intravasculaire (IVaS) : le « Clip Stent ». Annales de Chirurgie Plastique Esthétique. 2011;56(6):512-517. doi:10.1016/j.anplas.2011.09.007
  • 8. Koutsomanis A, Hendriks S, Schohn T, Zemirline A, Liverneaux PA, Facca S. Pull out stent: A trick to improve the intravascular stenting technique. Chir Main. 2014;33(4):251-255. doi:10.1016/j.main.2014.04.004
  • 9. Hong JP (Jp), Song S, Suh HSP. Supermicrosurgery: Principles and applications. J Surg Oncol. 2018;118(5):832-839. doi:10.1002/jso.25243
  • 10. Masia J, Olivares L, Koshima I, et al. Barcelona Consensus on Supermicrosurgery. J Reconstr Microsurg. 2013;30(01): 053-058. doi:10.1055/s-0033-1354742
  • 11. Buncke HJ. Microsurgical research—a personal experience. Microsurgery. 1995;16(4):186-190. doi:10. 1002/micr.1920160405
  • 12. Shurey S, Akelina Y, Legagneux J, Malzone G, Jiga L, Ghanem AM. The Rat Model in Microsurgery Education: Classical Exercises and New Horizons. Arch Plast Surg. 2014;41(03):201-208. doi:10.5999/aps.2014.41.3.201
There are 12 citations in total.

Details

Primary Language English
Subjects Orthopaedics
Journal Section Research Articles
Authors

Çağdaş Pamuk 0000-0001-6766-4969

Publication Date February 28, 2023
Submission Date November 29, 2022
Acceptance Date February 25, 2023
Published in Issue Year 2023 Volume: 6 Issue: 1

Cite

AMA Pamuk Ç. Folded-Stent: The Third Generation Trick to Improve The Microvascular Stenting Technique. Acta Med Nicomedia. February 2023;6(1):107-112. doi:10.53446/actamednicomedia.1211765

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