J Reconstr Microsurg
DOI: 10.1055/s-0040-1718548
Original Article

The Double Stitch Everting Technique in the End-to-Side Microvascular Anastomosis: Validation of the Technique Using a Randomized N-of-1 Trial

George C. Dindelegan
1  Department of Surgery, First Surgical Clinic, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
2  Department of Experimental Microsurgery, Center for Surgical Simulation, Training and Microsurgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
,
Ruben Dammers
3  Department of Neurosurgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
,
Alex V. Oradan
2  Department of Experimental Microsurgery, Center for Surgical Simulation, Training and Microsurgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
4  Department of Plastic Surgery, Rehabilitation Hospital, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
,
Ramona C. Vinasi
2  Department of Experimental Microsurgery, Center for Surgical Simulation, Training and Microsurgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
5  Department of Psychiatry, Cluj County Hospital, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
,
Maximilian Dindelegan
2  Department of Experimental Microsurgery, Center for Surgical Simulation, Training and Microsurgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
6  Department of Otorhinolaryngology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
,
2  Department of Experimental Microsurgery, Center for Surgical Simulation, Training and Microsurgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
3  Department of Neurosurgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
7  Department of Public Health, Center for Medical Decision Making, Erasmus MC University Medical Center, Rotterdam, The Netherlands
› Author Affiliations
Funding None.

Abstract

Background The double stitch everting (DSE) technique, in which time is won by leaving the needle inside the vessel wall in-between stitching, is a modification of the end-to-side (ETS) anastomosis in the interest of reducing anastomosis time. This ensures proper wall eversion, intima-to-intima contact, and improved suture symmetry.

Materials and Methods We designed an N-of-1 randomized trial with each microsurgeon as their own control. We included 10 microsurgeons of different levels of experience who were then asked to perform classic and DSE ETS anastomoses on the chicken leg and rat femoral models. Every anastomosis was cut and evaluated using blinded assessment. Two-way analysis of variance (ANOVA) and multivariable logistic regression were used to analyze the results and for confounder adjustment.

Results A total of 210 anastomoses were performed, of which 177 on the chicken leg and 43 on the rat femoral artery and vein. From the 210 anastomoses, 111 were performed using the classic technique and 99 using the DSE technique. The mean anastomosis time was 28.8 ± 11.3 minutes in the classic group and 24.6 ± 12 minutes in the DSE group (p < 0.001, t-test). There was a significant reduction (p < 0.001, two-way ANOVA) in the number of mistakes when using the DSE technique (mean 5.5 ± 2.6) compared with those using the classic technique (mean 7.7 ± 3.4).

Conclusion The DSE technique for ETS anastomoses improves anastomoses times in experienced and moderately experienced microsurgeons while also improving or maintaining suture symmetry and lowering the number of mistakes.



Publication History

Received: 16 June 2020

Accepted: 02 September 2020

Publication Date:
14 October 2020 (online)

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