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From simple interrupted to complex spiral: A systematic review of various suture techniques for microvascular anastomoses
Author(s) -
Alghoul Mohammed S.,
Gordon Chad R.,
Yetman Randal,
Buncke Gregory M.,
Siemionow Maria,
Afifi Ahmed M.,
Moon Wong K.
Publication year - 2011
Publication title -
microsurgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.031
H-Index - 63
eISSN - 1098-2752
pISSN - 0738-1085
DOI - 10.1002/micr.20813
Subject(s) - medicine , anastomosis , fibrous joint , surgery , microsurgery , suture line
Accomplishing successful microvascular anastomoses is undoubtedly one of the most critical steps in performing free tissue transfer. However, the ideal technique has often been a subject of debate. Therefore, our objective was to review the current literature in an attempt to find objective evidence supporting the superiority of one particular technique. A PubMed and OVID on‐line search was performed in November 2007 using the following keywords: microvascular anastomoses, microsurgical anastomosis, continuous suture, interrupted suture, mattress suture, and sleeve anastomosis. Our literature review found no difference in short‐ and/or long‐term patency rates between the six main published techniques, which includes continuous suture, interrupted suture, locking continuous, continuous horizontal, horizontal interrupted with eversion, and sleeve anastomoses. These findings were consistent for each technique as long as the microsurgeon maintained standard microsurgical principles and practice, including suture line eversion, minimized tension, and direct intima‐to‐intima contact. Current literature supports no overall statistical difference in short‐ and/or long‐term patency rates between any of the various techniques. The choice to perform one suture technique over another ultimately depends on the plastic surgeon's preference and microsurgical experience. To date, there are no human randomized, controlled clinical trials comparing the efficacy and clinical outcomes of each of the various suture techniques, and therefore one's comfort and familiarity should dictate his or her microsurgical technique. However, “exposure to many and mastery of one” simply provides the plastic surgery resident, fellow, or staff the technical flexibility needed for less‐complicated surgical planning when performing free tissue transfer. © 2010 Wiley‐Liss, Inc. Microsurgery, 2011.