LIGACLIP-assisted venous anastomosis: a faster, cost-effective, and easy to master technique for venous anastomosis
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ORIGINAL PAPER
LIGACLIP-assisted venous anastomosis: a faster, cost-effective, and easy to master technique for venous anastomosis A prospective comparative study Guru Dayal Singh Kalra 1 & Samarth Gupta 1
&
Sushrut Kalra 1
Received: 13 August 2020 / Accepted: 26 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background In the advancing field of microsurgery, as more complex procedures are being performed, new advances and ideas are necessities. Suturing a vein remains a challenging task for young plastic surgeons, owing to its technical difficulty and labor intensity, leaving them underconfident to perform anastomosis in their practice. Not only does this lead them to delay the process of performing free flaps independently, but it also affects their work efficacy. With the advent of couplers, it does seem to theoretically reduce these disadvantages; however, it has not been proven clinically. These devices have complex and cumbersome instrumentation, reducing vascular distensibility, hence disabling them for significant vessel size discrepancies or end-toside anastomosis. Methods We have devised a quick, easy to perform modality of venous anastomosis which can aid a young surgeon to quickly acclimatize this domain of microsurgery as they pass out of their residency programs. The technique utilizes the creation of 4 flaps in the vessel wall and everting them as they oppose the corresponding vessel, followed by the use of LIGACLIPs to seal these flaps, thereby utilizing minimal micro-suture knots to finish the anastomosis.The study population of 50 patients underwent venous anastomosis done for free flaps having vessel diameter > 2.5 mm. Of the 50 recruited patients, 25 of them underwent conventional suturing technique and they represented the control group, whereas, on the other hand, the remaining 25 patients underwent LIGACLIP-assisted venous anastomosis. Data was then analyzed after assessing the total duration to perform anastomosis and re-exploration rates. Results The 25 participants who underwent LIGACLIP-assisted venous closure (M = 13.5 mins) compared to the 25 participants in the control group (M = 29.5) demonstrated significantly lesser anastomosis time (p < 0.05). In the case group, there was no flap failure in any of the patients. In the control group, three patients were re-explored, one of the patients was found to have hematoma (in head and neck reconstruction) which was cleared off and the flap survived. The other two patients had thrombosis (both for lower limb reconstruction), one of which was successfully re-vascularized and the other went into flap necrosis. Conclusions LIGACLIP-assisted venous anastomosis is a safe, faster, and simple technique to master venous anastomosis. It omits the tedious process of placing multiple micro-sutures in large-caliber venous walls and provides us with a simpler solution. We believe that this technique should encourage young surgeons to take up microsurgery early in their practice and thereby adding more options in rec
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