Abstract
Background The nitinol U-clip (Medtronic, Inc.; Minneapolis, MN, USA) is similar to conventional
suturing but eliminates knot tying, thereby decreasing ischemia time. This study is
the first clinical trial of this new technology for arterial microsurgical anastomoses
in free tissue transfer.
Methods We performed a prospective clinical trial of nitinol U-clips for 25 consecutive arterial
microsurgical anastomoses. Standard microsurgical techniques and instruments were
used, and the primary outcome was free flap survival. The secondary outcomes were
ischemia time, operating room (OR) time, number of clips used, and recipient/donor-site
complications. Significant recipient/donor-site complications were defined as those
requiring re-operation. Descriptive statistics were used and minimum follow-up was
3 months.
Results All anastomoses were successful (25/25). The most common etiology of the defect was
cancer resection (92%), and 44% of the recipient vessels had been irradiated prior
to surgery. Mean ischemia time was 29 minutes (range 12 to 54 minutes), and mean OR
time was 7.4 hours. On average, seven U-clips were used per arterial anastomosis (range
5 to 12). At 3-month follow-up, there was a 100% flap survival rate with no significant
recipient-site or donor-site complications.
Conclusion This study suggests that the nitinol U-clip provides rapid, reproducible microvascular
arterial anastomoses.
Keywords
U-clips - microvascular anastomosis - free flap
