Vascular anastomosis

Vascular anastomosis is widely used, mainly by suturing broken blood vessels with absorbable lines to restore vascular function. Treatment of diseases: vascular injury, hand vascular injury, limb vascular injury Indication A well-known blood vessel in any part of the body is broken, life-threatening, and affects the blood circulation at the distal end of the limb. Contraindications 1. The general condition cannot tolerate the operator. 2. The limb is incompletely disconnected, and the distal limb (finger) body has undergone degeneration and necrosis. Preoperative preparation Antibiotics are routinely used before surgery. Surgical procedure 1. Anesthesia: Choose the appropriate anesthesia according to the injury and age. 2. Position: Select the appropriate position according to the part. 3. The principle of vascular anastomosis (1) It should be a normal blood vessel: debridement through the blood vessels, so that the two vascular ends return to normal structure and elasticity, and the lumen is washed with heparin saline without any blood clots and cellulose deposition, so that the endometrium is bright, complete and open. After the vessel clamp, a strong blood spurt appears in the proximal artery. (2) The same diameter of the blood vessels: after debridement and bone shortening, the diameter of the two vessels should be basically the same. (3) suture without tension: the general limb (finger) body can be sutured without tension after the bone is shortened. In patients with vascular defects, vascular graft repair can be used. (4) Good vascular bed and skin coverage: There should be a healthy and smooth soft tissue bed at the vascular anastomosis; normal skin coverage should be provided in the blood vessel path; skin defect can be covered with a transfer flap. 4. Vascular anastomosis essentials (1) The margin and stitch length are symmetrical. (2) Vertically in and out of the needle. (3) Maintain suture tension during knotting to achieve flattening of the blood vessels or eversion of the endometrium. 5. Vascular suture material should use 8-0~12-0 needle-free atraumatic suture, 8-0~9-0 suture is often used for replantation of broken limbs, and 9-0~12-0 is often used for replantation of severed fingers. Suture. 6. Vascular suture method (1) End-to-end anastomosis: The vascular end-to-end anastomosis is the most commonly used method of vascular anastomosis in clinical practice. 1 two fixed stitching method: according to the operating microscope, press the clock position to fix the point. The near-operator position is 6 points, the corresponding side is 12 points, the right middle side is 3 points, and the left middle side is 9 points. First suture 12 o'clock and 6 o'clock, you can also suture 3 o'clock and 9 o'clock first. After the corresponding two needles are sutured according to the vascular anastomosis, under the traction of the assistant or the traction hammer, a gap is formed in the anterior wall of the blood vessel. Evenly add a few stitches, reverse the front wall of the blood vessel by 180°, and then evenly add a few stitches on the back wall. 2 Isometric four-point stitching method: It is evolved from the two-point stitching method, that is, after sewing one stitch at 12 o'clock, 3 o'clock, 6 o'clock and 9 o'clock, even 1 or 2 stitches are evenly added. 3 three fixed stitching method: only the change of the fixed stitching position, first stitching 1 stitch at 12 o'clock and 4 o'clock, and then evenly stitching 1~3 stitches. (2) End-to-side anastomosis: In order to maintain the continuity of well-known blood vessels and blood circulation at the distal end of the limb, the blood circulation of the free tissue can be reconstructed by end-to-side anastomosis. The operation method is as follows. The transplanted vascular end was cut into a 30° slope. The acute angle of the oblique surface of the artery is toward the proximal end, and the acute angle of the oblique surface of the vein is toward the distal end. After the diameter of the oblique section is estimated, the blood flow is blocked by the two blood vessel clips between the main blood vessel segments of the path, and the blood vessel is sutured with a 9-0 on the anterior wall of the blood vessel. The needle thread is sutured through the wall of the blood vessel which is intended to be an opening, and the suture is lifted to make a small hillock appear on the wall of the tube, and the small hillock is cut by a microspring to form an elliptical blood vessel gap so that the size of the gap is equal to or slightly larger than the graft vessel. The oblique section can be. The end of the obtuse angle that has been cut into an obtuse angle is first sutured horizontally with the distal side of the main vessel incision (near the vein), with one end of the acute angle and the proximal side of the main vessel gap (the vein is distal) Then make a horizontal suture stitching, and then make a four-point suture stitching at the midpoints on both sides, and finally add 1 or 2 stitches between the four fixed points according to the diameter of the blood vessel. (3) vascular nesting anastomosis Advantages: The suture is rarely exposed in the vascular lumen, the intima is not damaged, and the number of sutures is small, but the patency rate is lower than the end suture method. Take the arterial nesting suture method as an example. Firstly, the proximal epidural tissue of the artery was properly exfoliated. The proximal side of the vascular section was placed at an interval of 120° at a distance of 1.5 times the diameter of the vessel, and the external muscle layer was placed along the longitudinal axis of the vessel. Each stitch is 1 needle, and then the above 3 sutures are spaced 120° apart at the distal edge of the artery, and 1 stitch is made from the inner and outer layers. The proximal end of the artery is gently inserted into the distal end of the artery with the help of the assistant. Tighten 3 sutures to tie the knot behind the wall. Open the blood vessel clamp and fill the needle if there is blood leakage. The venous nesting suture is inserted in the opposite direction.