Reducing Anastomotic Time - Technical Aspects Of Using The VCS? Clip Applier For Microvascular Anastomosis In Free Flap Surgery.

摘要

Technical aspects of using the VCS(r) clip applier (a nonpenetrating titanium clip applied in an interrupted, everting fashion) for microvascular anastomoses are discussed. This technique has the advantage that it can be used for arterial, venous, end-to-side, and end-to-end anastomoses. It is a fast, reliable technique, with a very low complication rate, which can reduce total anastomotic time to 10-20 minutes. This technique has definite advantages in complex or lengthy reconstructions eg where 2 free flaps are being performed, where vein grafts are being used, or where access to the anastomosis is limited. INTRODUCTION Free flaps have now become a routine part of reconstructive surgery practice. Although failure rates have decreased with increasing experience, there is still a significant failure rate, even in the best hands. Many free flap failures are due to technical problems in performing the anastomosis. To try to reduce the complication rate there have been many alternatives developed to sutured anastomoses, including cuffs/couplers, penetrating staples, adhesives, and laser welding.1,2,3,4,5,6,7,8. Although many of these anastomotic devices have been available for many years, none has gained widespread acceptance. The most popular of these, the 3M precise microanastomotic vascular system has been available for 10 years, with 2 clinical studies showing the effectiveness of this system 9,10. The VCS(r) clip applier (a nonpenetrating titanium clip applied in an interrupted, everting fashion) was first reported in 199211, and has recently been shown to be an effective method of performing microvascular anastomoses in a large clinical series12. This technique has a number of advantages over other non-suture methods. Not only can it significantly reduce the anastomotic time, but it also has a very low complication rate. In this report we give details, including potential pitfalls, of the technique. TECHNIQUE The VCS(r) (vascular closure staple) clip is an arcuate-legged, nonpenetrating titanium clip manufactured by Autosuture. It is available in 3 sizes (see below), 2 of which are applicable to microsurgery – the small (0.9mm) and medium (1.4mm) sizes. The larger size is only applicable for macrovascular anastomoses.