J Cerebrovasc Endovasc Neurosurg.  2023 Sep;25(3):260-266. 10.7461/jcen.2023.E2023.01.005.

A comparison study of vessel twisting by different microsurgical suture techniques in a chicken wing artery side to side bypass training model

• Jung J
• Jeong D

• KMID: 2546162
• DOI: http://doi.org/10.7461/jcen.2023.E2023.01.005

Abstract

Objective
Microvascular anastomosis, particularly side-to-side (STS) bypass, is a complex surgical procedure. While several suture techniques exist, none of them is superior to the others. We assessed the association between various STS bypass techniques and vessel twisting using chicken wing training models.
Methods
Three suture techniques were compared over an anterior wall suture procedure. The unidirectional continuous suture (UCS) group used a downward “right-to-left” continuous suture. The reverse continuous suture (RCS) group used a downward “left-to-right” continuous suture. The interrupted suture (IS) group used the standard interrupted suture. The number of samples in each of the three groups was 30 (n=90). We compared the incidence of vessel twisting and rotation angles across groups.
Results
Vessel twisting occurred in 96.7%, 56.7%, and 0% of the cases in the UCS, IS, and RCS groups, respectively. The incidence of vessel twisting differed significantly in all 3 groups (p<0.001), with an apparent trend (p=0.002). The mean rotation angles were 201˚±90.6˚, 102˚±107.6˚, and 0˚ in the UCS, IS, and RCS groups, respectively, which were significantly different (p<0.001). On excluding cases without twisting, the rotation angles of twisted vessels in the UCS and IS groups were 207.9˚±83.7˚ and 180˚±77.9˚, respectively, which yielded a significant difference between these groups (p<0.001).
Conclusions
We found that the incidence and trend of vessel twisting differed significantly across suture techniques. The RCS technique may aid in preventing vessel twisting in the STS bypass procedure.

Keyword

Cerebral revascularization; Microsurgery; Suture techniques

Figure

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  Fig. 1. Photographs of vessel samples in this study. All twisted samples are rotated counterclockwise. (A) A 360˚-rotated sample with unidirectional continuous suture. (B) A 180˚-rotated sample with interrupted suture. (C) A non-twisted sample with the reverse continuous suture technique.

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  Fig. 2. Schematic illustration of the lower stay suture knot positions in the perpendicular plane. The rotation angle was measured based on imaginary dotted line and marked as green arc angle. All samples did not twist over 360 degree in this study. (A) 0 or 360 degree, (B) 90 degree, (C) 180 degree, (D) 270 degree twisted vessels.

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  Fig. 3. Schematic illustrations of torque generation with a “right-to-left” downward-directed continuous suture at the suture line. Thread tightening force (green arrows) and reactive force/torque (blue arrows). (A) Planar view of the suture line. (B) Three-dimensional view of the suture line. Counterclockwise reactive torques are generated at the suture line.

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  Fig. 4. Schematic illustrations of the vector sum of the torques in the transverse view. Reactive torque (blue arrows). (A) Counterclockwise torques at both suture lines in the unidirectional continuous suture group. These torques act synergistically. (B) Opposite directional torques offset each other in the reverse continuous suture group.

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