Summary
Microvascular clamps of various designs provide a bloodless field for a safe anastomosis
but can cause intimal lesions, occupy space in confined sites and have a risk of backwalling
due to vessel flattening. They are often insufficient in their haemostatic effect
in plaque-filled atherosclerotic vessels. A new, CE-certified thermosensitive gel
(LeGoo™) clinically proven in cardiovascular surgery allows a clampless microanastomosis
technique.
We operated on a series of five consecutive patients aged 24–71 years with six flaps
for lower-extremity reconstruction using a clampless anastomosis technique with LeGoo™.
We transplanted one fabricated chimaeric fibula plus gracilis, three gracilis muscle
and one anterolateral thigh (ALT) flap. Pre- and postoperative protocols were similar
to a ‘standard’ procedure with micro-clamps.
All flaps survived completely except for a small area on fibula skin island, which
was unrelated to gel use. The gel-assisted technique has a quick learning curve, according
to this case series. The veins should be sutured first to prevent stasis in the flap.
The gel provides circular stenting and gentle distension of the vessels for a safe
and blood-free anastomotic site. It is completely dissolved after completion of the
anastomosis with cold saline irrigation. Repolymerisation in the periphery will not
occur, making it safe for microvascular flap surgery.
From the experiences from this series and other specialities, the use of the thermosensitive
gel LeGoo™ permits a safe clampless microanastomosis technique minimising mechanical
vessel manipulation and compression. This makes it an attractive alternative to micro-clamps,
especially for atherosclerotic arteries and confined anastomosis sites.
Keywords
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Article info
Publication history
Published online: August 08, 2011
Accepted:
July 13,
2011
Received:
July 7,
2011
Identification
Copyright
© 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
