Technology-assisted and sutureless microvascular anastomoses

Evidence for current techniques

George F. Pratt, Warren Rozen, Angie Westwood, Angela Hancock, Daniel Chubb, Mark W. Ashton, Iain S. Whitaker

Research output: Contribution to journalReview ArticleResearchpeer-review

16 Citations (Scopus)

Abstract

Background: Since the birth of reconstructive microvascular surgery, attempts have been made to shorten the operative time while maintaining patency and efficacy. Several devices have been developed to aid microsurgical anastomoses. This article investigates each of the currently available technologies and attempts to provide objective evidence supporting their use. Methods: Techniques of microvascular anastomosis were investigated by performing searches of the online databases Medline and Pubmed. Returned results were assessed according to the criteria for ranking medical evidence advocated by the Oxford Centre for Evidence Based Medicine. Emphasis was placed on publications with quantifiable endpoints such as unplanned return to theatre, flap salvage, and complication rates. Results: There is a relative paucity of high-level evidence supporting any form of assisted microvascular anastomosis. Specifically, there are no randomized prospective trials comparing outcomes using one method versus any other. However, comparative retrospective cohort studies do exist and have demonstrated convincing advantages of certain techniques. In particular, the Unilink™/3M™ coupler and the Autosuture™ Vessel Closure System® (VCS®) clip applicator have been shown to have level 2b evidence supporting their use, meaning that the body of evidence achieves a level of comparative cohort studies. Conclusion: Of the available forms of assisted microvascular anastomoses, there is level 2b evidence suggesting a positive outcome with the use of the Unilink™/ 3™ coupler and the Autosuture™ VCS® clip applicator. Other techniques such as cyanoacrylates, fibrin glues, the Medtronic™ U-ClipA®, and laser bonding have low levels of evidence supporting their use. Further research is required to establish any role for these techniques.

Original languageEnglish
Pages (from-to)68-76
Number of pages9
JournalMicrosurgery
Volume32
Issue number1
DOIs
Publication statusPublished - Jan 2012
Externally publishedYes

Cite this

Pratt, G. F., Rozen, W., Westwood, A., Hancock, A., Chubb, D., Ashton, M. W., & Whitaker, I. S. (2012). Technology-assisted and sutureless microvascular anastomoses: Evidence for current techniques. Microsurgery, 32(1), 68-76. https://doi.org/10.1002/micr.20930
Pratt, George F. ; Rozen, Warren ; Westwood, Angie ; Hancock, Angela ; Chubb, Daniel ; Ashton, Mark W. ; Whitaker, Iain S. / Technology-assisted and sutureless microvascular anastomoses : Evidence for current techniques. In: Microsurgery. 2012 ; Vol. 32, No. 1. pp. 68-76.
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Pratt, GF, Rozen, W, Westwood, A, Hancock, A, Chubb, D, Ashton, MW & Whitaker, IS 2012, 'Technology-assisted and sutureless microvascular anastomoses: Evidence for current techniques', Microsurgery, vol. 32, no. 1, pp. 68-76. https://doi.org/10.1002/micr.20930

Technology-assisted and sutureless microvascular anastomoses : Evidence for current techniques. / Pratt, George F.; Rozen, Warren; Westwood, Angie; Hancock, Angela; Chubb, Daniel; Ashton, Mark W.; Whitaker, Iain S.

In: Microsurgery, Vol. 32, No. 1, 01.2012, p. 68-76.

Research output: Contribution to journalReview ArticleResearchpeer-review

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AU - Pratt, George F.

AU - Rozen, Warren

AU - Westwood, Angie

AU - Hancock, Angela

AU - Chubb, Daniel

AU - Ashton, Mark W.

AU - Whitaker, Iain S.

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N2 - Background: Since the birth of reconstructive microvascular surgery, attempts have been made to shorten the operative time while maintaining patency and efficacy. Several devices have been developed to aid microsurgical anastomoses. This article investigates each of the currently available technologies and attempts to provide objective evidence supporting their use. Methods: Techniques of microvascular anastomosis were investigated by performing searches of the online databases Medline and Pubmed. Returned results were assessed according to the criteria for ranking medical evidence advocated by the Oxford Centre for Evidence Based Medicine. Emphasis was placed on publications with quantifiable endpoints such as unplanned return to theatre, flap salvage, and complication rates. Results: There is a relative paucity of high-level evidence supporting any form of assisted microvascular anastomosis. Specifically, there are no randomized prospective trials comparing outcomes using one method versus any other. However, comparative retrospective cohort studies do exist and have demonstrated convincing advantages of certain techniques. In particular, the Unilink™/3M™ coupler and the Autosuture™ Vessel Closure System® (VCS®) clip applicator have been shown to have level 2b evidence supporting their use, meaning that the body of evidence achieves a level of comparative cohort studies. Conclusion: Of the available forms of assisted microvascular anastomoses, there is level 2b evidence suggesting a positive outcome with the use of the Unilink™/ 3™ coupler and the Autosuture™ VCS® clip applicator. Other techniques such as cyanoacrylates, fibrin glues, the Medtronic™ U-ClipA®, and laser bonding have low levels of evidence supporting their use. Further research is required to establish any role for these techniques.

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