[From microsurgery to supermicrosurgery: Experimental feasibility study and perspectives]

Abstract

Introduction: Supermicrosurgical techniques developed for the anastomoses less or equal to 0.5mm show convincing results in specialized centers and with an advanced instrumentation. Can we integrate supermicrosurgical training animal models in the current teaching program of microsurgery?.

Materials and methods: Ten arterial anastomoses of the inferior epigastric artery (diameter less than or equal to 0.5mm) were performed consecutively in five rats by the same beginner operator in microsurgery, with standard microsurgical set of instruments. The intravascular stenting anastomosis method was used with 11-0 nylon sutures. The immediate patency and flap survival on postoperative day three was assessed. The duration of each anastomosis was measured.

Results: The mean diameter of the arteries was 0.4mm. The average time for each anastomosis was 30 minutes with a maximum of 55 minutes and a minimum of 18 minutes. The average number of stitches was 5.5. The immediate patency was 100 % with a 70 % success rate at the third day.

Conclusions: There are several applications of supermicrosurgical techniques, especially in hand surgery, lymphoedema surgical treatment and for perforator-to-perforator flaps. The intravascular stenting method allows fast learning of the technique with a satisfactory success rate despite non-specific instrumentation. Furthermore, this method could easily be integrated among the microsurgical courses of many universities.