Summary
The achievement of patency of the microvascular anastomosis in free flap surgery is
dependent on a number of factors, central to which is atraumatic handling of the vessel
lumen, and intimal apposition. Initial laboratory studies demonstrating the superiority
of the non-penetrating vascular closure staple (VCS – Anastoclip ®) were followed
by our report in 1999 on a series of free flaps. There is still a paucity of data
in the literature on the use of non-penetrating devices for microvascular anastomosis,
and our review gives evidence to support the routine use of the VCS in microsurgical
free flap surgery. We now report on its successful use over a thirteen year period
in 819 free flap reconstructions. Our data indicates the VCS device to be as effective
as sutured anastomoses in free tissue transfer surgery. There is also statistically
significant data (Barnard’s Exact Test) to demonstrate a higher vascular patency rate
of the VCS device over sutured anastomoses when sub group analysis is performed. ‘Take-back’
revision rates were lower amongst flaps that employed VCS use. For arterial anastomoses,
this equated to 3/654(0.05%) vs 4/170(2.4%) with hand-sewn anastomoses (p = 0.02). Similarly, for venous anastomoses the ‘take-back’ revision rate was 7/661(1.1%)
vs 8/165(4.8%) with hand-sewn anastomoses (p = 0.003). Furthermore, the major advantage of the VCS is reduction in anastomosis
time, from approximately 25 min per anastomosis for sutures to between five and 10 min
for staples.
Keywords
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Article info
Publication history
Published online: October 12, 2011
Accepted:
August 21,
2011
Received:
May 29,
2011
Footnotes
☆This body of work has not been presented previously.
Identification
Copyright
© 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
