end-to-end suture

End-to-end suture is the most common and basic method for small blood vessel suture, which is the most consistent with the physiological blood flow direction and can best maintain the maximum flow rate and flow rate of blood. Treatment of diseases: systemic idiopathic telangiectasia hereditary hemorrhagic telangiectasia Indication Normal blood vessels with vascular pedicle tissue grafting (including the vascular graft that can be severed must also be normal); there is no vascular defect between the two fracture ends of the vascular rupture, which can be sutured without tension; the outer diameter of both anastomotic vessels is close, or The difference is less than 1/3 of the outer diameter, suitable for end-to-end suture. Surgical procedure 1. Expose the blood vessel according to the anatomical part of the blood vessel and the direction of travel, cut the skin, subcutaneous tissue and fascia, and open the muscle layer to reveal the vascular nerve bundle. Bleeding points were stopped by bipolar coagulation, or ligated with 3-0 to 5-0 nylon monofilament. The tip of the microvascular forceps or microscopic forceps is inserted between the vascular nerves and separated along the longitudinal axis of the blood vessel to reveal the blood vessels and nerves one by one. 2. Place the microvascular clamp and the micro-closer, separate the blood vessel or its broken end, and block the blood flow with the microvascular clamp connected to the closet. The direction should be perpendicular to the blood vessel, and the distance between the two blood vessel clips is 10 to 15 mm or 5 to 8 mm at the end. A colored plastic film of about 10 x 10 mm2 size was placed behind the blood vessel to serve as a backing. 3. Cut the blood vessel, peel off the outer membrane and cut the blood vessel at a right angle with the blood vessel or cut the blood vessel at the right angle. The broken end is retracted. At this point, the two ends can be brought together by a close-up to reduce the tension. Then use the irrigation needle to extend into the lumen of the vascular end, and use heparin saline to flush out the blood and blood clots in the cavity. Finally, the left hand holding the forceps clamps the adventitia membrane outside the broken end of the blood vessel to the broken end, and the right hand is sheared. The flat blood vessel is cut off to the adventitia membrane, and the remaining adductor membrane is retracted, making the white The vascular end is exposed to about 2 to 3 mm for suturing. 4. Stitching (1) Two fixed point suture method: After closing the lumen with a small blood vessel clamp, the upper and lower corners of the vascular broken end are round 0° and 180°, and the left hand of the surgeon extends the tip of the fistula into the lumen to open the needle. The non-invasive needle thread of the double needle is clamped at two points of 0° and 180° corresponding to the two broken ends of the blood vessel, and one needle is separated from the inner membrane to the outer membrane by about 0.1 to 0.2 mm from the edge. When the needle is inserted, the needle is perpendicular to the vessel wall and is simultaneously pressurized with the tip of the fistula to assist the needle. When knotting, gently pull the suture, and the assistant gently presses the incision to make the endometrium valgus and then knot, usually three flat knots. After knotting, one suture is cut and the other suture is left for traction. The front wall is firstly sewed under the relative traction of the two fixed-point traction lines, that is, at the midpoint of the first needle and the second needle, from the outside to the inside, and the third stitch is not ligated from the inside to the outside for the purpose of seeing the lumen . Then, at the midpoint of the third needle and the first needle and the second needle, one stitch is formed for each stitch. Turn the closer 180° and observe whether the 3rd, 4th, and 5th stitches are sewn and the back wall. If the stitches are not sewn and the back wall, the stitches of the 3rd, 4th, and 5th stitches can be knotted and cut. After the anterior wall is sutured, the traction line is adjusted, and the micro-closer and the blood vessel clamp are turned 180° to expose the rear wall. The back wall is sewn in the same way, that is, the sixth stitch is first stitched [the midpoint of the first stitch and the second stitch], and then the seventh stitch and the eighth stitch are sewn at the midpoint of the sixth stitch and the first stitch and the second stitch. needle. Generally, a blood vessel with an outer diameter of about 1 mm is sufficient for suturing 8 needles. Due to the different diameter of the blood vessels, some only need to sew 6 needles, and some need to sew 10 needles. The order of suturing is shown in the figure. (2) Three-point suture method: 90°, 210° and 330° at the two ends of the blood vessel, each suture is stitched, so that the intima is properly conjugated and knotted to form three fixed points. Then, between the three needles, depending on the outer diameter of the blood vessel, each stitch is 1-2 needles, and the total number of stitches is 6 to 9 stitches. When suturing between the first needle and the second needle, the assistant can gently pull the suture of the third needle backward to separate the front and rear walls, so that the needle seam and the posterior wall of the blood vessel can be avoided. However, the disadvantage of the three-point stitching method is that the fixed point is not easy to be correct, and it is difficult to achieve equidistant stitching and uniform stitch length. Therefore, it is suitable for suturing blood vessels with thin walls and easy to fit together. 5. After the completion of the blood flow artery anastomosis, first go to the distal end of the blood vessel clamp, and then go to the proximal end of the blood vessel clamp to restore blood flow. If the suture is good, the blood vessel clamp is loosened, and the blood vessel is well filled. The distal artery has a beating motion. The anastomosis has only a slight blood leak. Press the saline cotton ball for 1 to 2 minutes to stop. Conversely, if the stitch length of the suture is not uniform, the anastomosis may have blood spurting or severe blood leakage. It is often necessary to block the blood flow and add a needle to trap the leak. However, the needle may easily sew the posterior wall and may cause suturing failure. 6. Check the smoothness of the anastomosis (the blood test) After the blood leakage stops, the operator gently grasps the upper part of the arterial or venous blood flow near the anastomosis with 2 microscopic tweezers, and moves the tweezers to the distal side of the anastomosis. In order to drive out the blood in the lumen of the blood vessel and pinch it, loosen the blood vessel and then remove the forceps at the proximal end of the blood flow to restore blood flow. If the blood quickly passes through the anastomosis, the compressed blood vessels are filled, suggesting that the anastomosis is unobstructed. Conversely, if the compressed blood vessels are filled slowly, it indicates that the anastomosis is partially obstructed; if the blood vessels are not filled, it indicates that the anastomosis is unreasonable, and the anastomosis must be removed and re-sewed. 7. According to the anatomical level, suture layer by layer and close the wound.