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- W4310485864 abstract "PURPOSE: The rat has long been regarded as the standard microsurgery research and training model. Anastomotic patency and thrombosis has since been a central focus in related studies. However, extensive literature indicates that rat microvessels are resilient and can remain patent despite clinically unacceptable technical errors. A design flaw in these studies is that they were oftentimes created by one or two experienced surgeons in a precise and standardized manner with only one technical error committed, which is not a typical representation of the clinical world. Therefore, this study aimed to investigate the effects of multiple errors committed by numerous surgeons on rat microvascular patency in an observational manner. METHODS: Forty-seven microsurgeons enrolled in the microsurgery course at Columbia University and University of Thessaloniki participated. Each surgeon performed two end-to-end anastomoses in the rat femoral artery and vein. Nighty-four arterial and 94 venous anastomoses were evaluated. Ten possible technical errors were examined using Anastomosis Lapse Index: 1: Disruption of suture line, 2: Back-wall stitch, 3: Oblique stitch, 4: Wide bite, 5: Partial thickness bite, 6: Unequal suture distance, 7: Tear in vessel wall, 8: Excessively tight suture, 9: Suture threads in lumen, and 10: Large edge overlap. The frequency of each error committed and the 30-min postoperative patency were recorded. Binary logistic regression was employed to investigate each technical error’s partial effect in the final patency rates. Significance is defined as P < 0.05. RESULTS: Only error 2 had a significant effect on patency (P < 0.001) in arterial anastomoses. Inverting the odds ratio, the odds an arterial anastomosis becomes thrombosed are 59 times greater than it can remain patent when error 2 is committed (OR = 0.017, 95% CI [0.002, 0.118]). Among venous anastomoses, besides error 2 (P < 0.001), error 4 (P = 0.003) and error 5 (P = 0.007) had significant effects. Inverting the odds ratio, the odds that a venous anastomosis becomes thrombosed are 1000, 6, and 3.6 times greater than it can remain patent, if one commits error 2 (OR = 0.001, 95% CI 0.000, 0.019), error 4 (OR = 0.164, 95% CI 0.051, 0.532) and error 5 (OR = 0.280, 95% CI 0.111, 0.702), respectively. DISCUSSION: Since the emergence and expansion of clinical microvascular surgery, vessel thrombosis remains one of the most critical issues. Among many factors that cause reduced patency and thrombosis formation, technical errors remain dominant. To investigate these technical errors’ thrombogenic effects, many experimental animal models, whereby a variety of deliberate errors were carried out. In the present study, it is shown the rat femoral vein is more sensitive than artery to selective technical errors. However, the overall results illustrate the rat model may be more forgiving of technical errors than the clinical situation regarding the anastomotic thrombosis formation. CONCLUSIONS: Given this discrepancy, we caution future researchers to take this factor into account when conducting and designing technical errors-induced microvascular thrombosis studies in the rat model. We also suggest that the microsurgery instructors focus on individual stitch quality rather than on the final patency." @default.
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- W4310485864 date "2021-10-01" @default.
- W4310485864 modified "2023-10-14" @default.
- W4310485864 title "A Comprehensive Investigation of the Effect of Technical Errors in Microsurgical Anastomotic Patency in the Rat Model" @default.
- W4310485864 doi "https://doi.org/10.1097/01.gox.0000799752.53266.14" @default.
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