Summary
Background and aim
In reconstructive surgery microsurgical repair of dissected arteries sometimes has
to be done under longitudinal tension. Guidelines to support an objective decision
on whether tension associated with direct suture is acceptable or whether grafting
is needed, do not exist. All experimental data found concerned the clinical outcome
of a certain length defect treated in various animal models. The aim of this study
was to show the feasibility of a new instrument for measuring the tension required
to adapt arterial stumps, thereby allowing surgical outcome to be assessed before
beginning anastomosis.
Material and methods
A modified tension spring balance was used to measure the force applied to the arterial
stumps before knotting. Twenty-four rat femoral arteries were dissected, segments
of up to 9 mm were resected, and the tension needed for approximation was measured. These ex-vivo
data were combined with clinical outcome data of previous animal trials.
Results
The tension measured increased proportionally to the size of the arterial gap created.
The correlation between tension and arterial gap was found to be almost linear. The
average additional time required for tension measurement using the Tyrolean Tensiometer
was 13 (±6) s.
Discussion
High anastomotic tension may cause critical or even poor clinical outcome. None of
the tension measurement methods described so far allow intraoperative measurement
at a time when changes in strategy are still possible. The Tyrolean Tensiometer for
the first time allows fast and reliable measurement of the tension acting on the first
suture of an anastomosis.
Keywords
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References
- Mechanical evaluation of anastomotic tension and patency in arteries.J Reconstr Microsurg. 1996; 12: 121
- Microvascular anastomosis of arteries under tension.Br J Plast Reconstr Surg. 1982; 35: 82
- Microvenous grafting of small vein defects.Br J Plast Reconstr Surg. 1979; 32: 164
- The effect of tension on patency of rat femoral artery anastomoses.Arch Facial Plast Surg. 2003; 5: 83
- Importance of vessel tension in end-to-end and end-in-end anastomoses.J Reconstr Microsurg. 1987; 3: 327
- Rat femoral vein-to-vein grafts as a microvascular practice model: factors that influence patency.Microsurgery. 1991; 12: 43
- Acute intraoperative arterial elongation: histologic, morphologic, and vascular reactivity studies.J Reconstr Microsurg. 1994; 10: 367
- Experimental micro-arterial grafts to small arteries.Br J Plast Surg. 1979; 32: 155
- Microvascular grafting.Clin Plast Surg. 1978; 5: 185
Article info
Publication history
Published online: March 27, 2006
Accepted:
December 9,
2005
Received:
July 31,
2005
Footnotes
☆Financial Support: None.
Identification
Copyright
© 2006 The British Association of Plastic Surgeons. Published by Elsevier Inc. All rights reserved.
