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Wu Y, Suo Y, Wang Z, Yu Y, Duan S, Liu H, Qi B, Jian C, Hu X, Zhang D, Yu A, Cheng Z. First clinical applications for the NIR-II imaging with ICG in microsurgery. Front Bioeng Biotechnol 2022; 10:1042546. [PMID: 36329697 PMCID: PMC9623121 DOI: 10.3389/fbioe.2022.1042546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/03/2022] [Indexed: 11/30/2022] Open
Abstract
In microsurgery, it is always difficult to accurately identify the blood supply with ease, such as vascular anastomosis, digit replantation, skin avulsion reconstruction and flap transplantation. Near-infrared window I (NIR-I, 700—900 nm) imaging has many clinical applications, whereas near-infrared window II (NIR-II, 1,000–1700 nm) imaging has emerged as a highly promising novel optical imaging modality and used in a few clinical fields recently, especially its penetration distance and noninvasive characteristics coincide with the needs of microsurgery. Therefore, a portable NIR-II imaging instrument and the Food and Drug Administration (FDA) approved indocyanine green (ICG) were used to improve the operation efficiency in microsurgery of 39 patients in this study. The anastomotic vessels and the salvaged distal limbs were clearly visualized after intravenous injection of ICG. The technique enabled identification of perforator vessels and estimation of perforator areas prior to the flap obtention and made it easier to monitor the prognosis. Overall, this study highlights the use of the portable NIR- II imaging with ICG as an operative evaluation tool can enhance the safety and accuracy of microsurgery.
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Affiliation(s)
- Yifan Wu
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yongkuan Suo
- Joint Laboratory for Molecular Medicine, Institute of Molecular Medicine, Northeastern University, Shenyang, Liaoning, China
| | - Zheng Wang
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yifeng Yu
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Shuang Duan
- Joint Laboratory for Molecular Medicine, Institute of Molecular Medicine, Northeastern University, Shenyang, Liaoning, China
| | - Hongguang Liu
- Joint Laboratory for Molecular Medicine, Institute of Molecular Medicine, Northeastern University, Shenyang, Liaoning, China
| | - Baiwen Qi
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Chao Jian
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xiang Hu
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Dong Zhang
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Aixi Yu
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- *Correspondence: Aixi Yu, ; Zhen Cheng,
| | - Zhen Cheng
- State Key Laboratory of Drug Research, Molecular Imaging Center, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, China
- Shandong Laboratory of Yantai Drug Discovery, Bohai Rim Advanced Research Institute for Drug Discovery, Yantai, Shandong, China
- *Correspondence: Aixi Yu, ; Zhen Cheng,
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Pafitanis G, Nicolaides M, O'Connor EF, Raveendran M, Ermogenous P, Psaras G, Rose V, Myers S. Microvascular anastomotic arterial coupling: A systematic review. J Plast Reconstr Aesthet Surg 2021; 74:1286-1302. [PMID: 33551362 DOI: 10.1016/j.bjps.2020.12.090] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 11/23/2020] [Accepted: 12/22/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION There are several reasons microsurgeons may not use a coupler device in arterial anastomosis: may be thick-walled, non-pliable due to atherosclerotic calcification or present vessel geometrical discrepancies. This review summarises the current applications, efficacy and troubleshooting of microvascular coupler devices in arterial end-to-end anastomosis. METHODS A systematic review of the literature was performed in November 2020 across 4 electronic databases and in accordance with the PRISMA guidelines. All studies comprised the data synthesis that reported the use of a microvascular coupler device for arterial end-to-end anastomosis. Data were extracted and collected in three groups of standardised variables: study, anastomosis-related and technical characteristics. RESULTS Out of the 7,690 articles identified, 20 were included in the final data synthesis. Included studies involved a total of 1639 patients, who underwent 670 arterial and 1,124 venous anastomoses. Out of all arterial anastomoses, 351 were performed in free tissue transfers in head and neck, 117 in breast, 4 in upper extremity and 5 in lower extremity reconstruction, whereas the remaining were not specified. The total arterial coupler anastomosis success rate reported was 92.1% (617/670). Fifty-three (8%) arterial anastomoses were reported to result in either troubleshooting events or intra- or post-operative failures, most being reported in extremity reconstructions. CONCLUSIONS Arterial coupling is not widespread with predominant use in head and neck and chest reconstructions, and total reported efficacy of 92.1%. Microsurgeons are reluctant to routinely use current widespread coupler devices as a result of inherent arterial characteristics. This study delivered collective recommendations, 'do's and don'ts' of microvascular arterial coupling.
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Affiliation(s)
- Georgios Pafitanis
- Group for Academic Plastic Surgery, The Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Department of Plastic Surgery, Guy's and St Thomas' Hospital, London, UK; Department of Orthoplastics Surgery, Kings College Hospital, London, UK; Department of Plastic Surgery, Emergency Care and Trauma Division, The Royal London Hospital, Bart's Health NHS Trust, London, UK.
| | - Marios Nicolaides
- Group for Academic Plastic Surgery, The Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Department of Plastic Surgery, Emergency Care and Trauma Division, The Royal London Hospital, Bart's Health NHS Trust, London, UK
| | - Edmund Fitzgerald O'Connor
- Group for Academic Plastic Surgery, The Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Department of Plastic Surgery, Guy's and St Thomas' Hospital, London, UK; Department of Orthoplastics Surgery, Kings College Hospital, London, UK
| | - Maria Raveendran
- Group for Academic Plastic Surgery, The Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - George Psaras
- Plastic Surgery Department, University of the Witwatersrand, Johannesburg, South Africa
| | - Victoria Rose
- Group for Academic Plastic Surgery, The Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Department of Plastic Surgery, Guy's and St Thomas' Hospital, London, UK; Department of Orthoplastics Surgery, Kings College Hospital, London, UK
| | - Simon Myers
- Group for Academic Plastic Surgery, The Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Department of Plastic Surgery, Emergency Care and Trauma Division, The Royal London Hospital, Bart's Health NHS Trust, London, UK
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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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Abstract
Autogenous vein is the conduit of choice in the surgical creation of bypasses of small-to-medium-caliber vessels in patients with peripheral occlusive arterial disease and will remain so for the near future. The success rate of bypasses using conduits of diameters greater than 6 mm has been excellent, whereas the majority of bypasses using smaller conduits fail within 5 years. In addition, due to a steep increase in rates of diabetes and decreasing cardiovascular mortality rates, increasing challenges are presented by this population. These facts have motivated much of the research in the cardiovascular arena over the past four decades, with improved techniques and new materials. Strategies to improve outcomes include the use of alternative materials including autologous, nonautologous and prosthetic grafts, utilizing different methods for their harvesting and preservation; tissue engineering, using either polymer- or biological-based scaffolds for cell seeding; endovascular methodologies; and gene therapy. This report presents an overview of the several options currently available in the management of patients with peripheral arterial occlusive disease, as well as the ongoing research directed towards the creation of an artificial engineered vessel, discussing experimental work in which endothelial cells have been seeded on different scaffolds and finally the potential application of gene therapy in the field of vascular reconstruction.
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Affiliation(s)
- Luis Leon
- Department of Surgery, Hines VA Hospital, IL 60141, USA.
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Liang X, Sun G, Hu B, Li J. Microvascular sutureless adhesive bonding anastomosis with a new soluble hollow stent. J Craniofac Surg 2013; 24:1823-7. [PMID: 24036788 DOI: 10.1097/scs.0b013e318285d36f] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was to assess a new soluble hollow stent used in an experimental sutureless adhesive bonding technique for microvascular anastomosis. Twenty-four New Zealand white rabbits were randomized into 2 groups. Twelve end-to-end anastomoses of carotid arteries were performed with glue and stent in group A. In control group B, 12 anastomoses were performed by manual suturing. Anastomoses were timed; immediate and late patency at 1 day, 7 days, and 3 weeks after surgery were evaluated by ultrasonography. Specimens were then analyzed histologically. This adhesive bonding technique took 7.02 ± 1.26 minutes to perform while the hand-sewn technique took 15.48 ± 2.10 minutes. Immediate and late patencies of the 2 groups were not statistically different. The new technique using glue and stent appeared to be timesaving, feasible, and efficient.
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Affiliation(s)
- Xiangdang Liang
- From the *Orthopedics Department, Chinese PLA General Hospital, Beijing; †Orthopedics Department, Chinese No. 252 Hospital of PLA, Hebei Province; and ‡The Clinic of No. 61646 Military Unit, Beijing, China
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Liu K, Yu H, Zhang M, Yu Y, Wang Y, Cai X. Sutureless primary repair of colonic perforation with a degradable stent in a porcine model of fecal peritonitis. Int J Colorectal Dis 2012; 27:1607-17. [PMID: 22664946 DOI: 10.1007/s00384-012-1511-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2012] [Indexed: 02/04/2023]
Abstract
PURPOSE Colonic perforation with fecal peritonitis is a life-threatening clinical condition. For these patients, a two-stage operation of fecal diversion and a postponed colostomy closure is generally recommended. Accordingly, a simple and feasible primary repair technique was explored. METHODS A sutureless banding method using a biodegradable stent and a porcine model of artificial colonic perforation were introduced. The colonic perforation model was created successfully with an open procedure in 34 pigs. The primary repair with a stent or the conventional hand-sewn control was performed 72 h later. Morbidity and mortality were recorded. Pigs in each group were also sacrificed to evaluate the healing on postoperative days (PODs) 3, 7, 14, and 90. The peripheral white blood cell counts, albumin, anastomotic bursting pressure, hydroxyproline contents, and histology data were evaluated. RESULTS There were 17 pigs in either group. Four pigs (23.5 %) of the control group died, but no mortality occurred in the stent group. There were no significant differences in white blood cell counts and albumin. Though anastomotic hydroxyproline contents between the two groups were comparable, the collagen per protein ratio on POD 14 in the stent group was higher, as well as the bursting pressure on PODs 3 and 7. Microscopically, the local inflammation of the cut edges in the control group was more severe, and the collagen synthesis started later. CONCLUSIONS A sutureless primary repair of a colonic perforation with a degradable stent is a feasible method in a porcine model of fecal peritonitis.
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Affiliation(s)
- Kun Liu
- Department of Hepatobiliary Surgery, Qingdao Municipal Hospital, Ocean University of China, Qingdao, China
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Romani R, Kivisaari R, Çelik Ö, Niemelä M, Perra G, Hernesniemi J. REPAIR OF AN ALARMING INTRAOPERATIVE INTRACAVERNOUS CAROTID ARTERY TEAR WITH ANASTOCLIPS: TECHNICAL CASE REPORT. Neurosurgery 2009; 65:E998-9; discussion E999. [DOI: 10.1227/01.neu.0000350877.43579.06] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE
Surgical treatment of an intracavernous carotid aneurysm (ICCA) is difficult because of the close relationship to bone, dura, and neurovascular structures. Intraoperative rupture of an ICCA is challenging, especially if the site of rupture is at the base of the aneurysm. We present a case of intraoperative rupture of an ICCA caused by clinoidectomy. We repaired it by using a single-clamp applicator (AnastoClip Vessel Closure System, 1.4 mm; LeMaitre Vascular, Burlington, MA).
CLINICAL PRESENTATION
In April 2007, a 40-year-old woman underwent neurosurgical treatment at another institution for a ruptured basilar bifurcation aneurysm, with good recovery. Digital subtraction angiography performed at this time showed the presence of left internal carotid artery aneurysms, 1 at the anterior wall of the paraclinoidal segment and 1 at the lateral wall of the intracavernous segment. In February 2008, the patient was referred from outside Finland to our department for microsurgical treatment of both aneurysms.
TECHNIQUE
A lateral supraorbital approach was used, and during extradural removal of the anterior clinoid with a rongeur, the ICCA ruptured. The base of the intracavernous aneurysm was involved in the rupture, and we used a single-clamp applicator to repair the internal carotid artery. Intraoperative digital subtraction angiography, indocyanine green video angiography, and Doppler ultrasonography showed a good flow in the artery. The paraclinoid aneurysm was uneventfully clipped during the same intervention.
CONCLUSION
Intraoperative rupture of ICCA was repaired quickly and effectively by using a single-clamp applicator. Our case and experimental data from other microsurgical vascular experiences suggest that the future of intracranial vessel repair/anastomoses will be using microclips and other simpler devices more, allowing the neurosurgeon to perform fast and effective vessel repair.
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Affiliation(s)
- Rossana Romani
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Riku Kivisaari
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Özgür Çelik
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Mika Niemelä
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Giancarlo Perra
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Juha Hernesniemi
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
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Chen HC, Mardini S, Tsai FC. “Airborne” Suture Tying Technique for the Microvascular Anastomosis. Plast Reconstr Surg 2004; 113:1225-8. [PMID: 15083025 DOI: 10.1097/01.prs.0000110216.33696.c8] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Hung-Chi Chen
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan.
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Pérez-Ruiz L, Pelayo-Salas A, Ros-López S, Gómez-Quiles L, Marco-Estarreado L. Microanastomosis venosa yuguloyugular contralateral. Un nuevo modelo experimental. ANGIOLOGIA 2004. [DOI: 10.1016/s0003-3170(04)74865-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
The development of experimental microsurgery can be considered the natural evolution of a diffuse need to increase precision in many fields of surgery. Microsurgery accelerated the possibility of deepening many unclear aspects of pathophysiology, using miniaturized and reproducible experimental models. We report briefly on the fundamental principles of microsurgery and the most frequently performed and useful models of experimental microsurgery, especially to employ as training models for surgeons, but also as bases for developing new and always-welcome models.
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Affiliation(s)
- A Di Cataldo
- First Surgical Clinic, University of Catania, Italy
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Comparison of indium 111 oxine—labeled platelet aggregation between sutured and argon laser—assisted vascular anastomoses. J Vasc Surg 1988. [DOI: 10.1016/0741-5214(88)90278-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Barrows T. Degradable implant materials: A review of synthetic absorbable polymers and their applications. ACTA ACUST UNITED AC 1986. [DOI: 10.1016/s0267-6605(86)80015-4] [Citation(s) in RCA: 164] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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