Vascular displacement graft suture method

Vascular transplantation is a commonly used method when blood vessels are defective and cannot be directly sutured. The transplanted blood vessels can be selected from autologous arteries, veins, or allogeneic arteries, veins, or artificial blood vessels. However, in microvascular surgery, autologous and vein grafts are still the most commonly used. Treatment of diseases: vascular injury, hand vascular injury, limb vascular injury Indication 1. In the case of free tissue transplantation, since the vascular pedicle of the transplanted tissue is too short and there is a defect between the blood vessel and the affected area, the free blood vessel or blood vessel displacement cannot be used to overcome the defect. 2. Defects caused by damaged blood vessels after debridement, or tumor invasion, cannot be overcome by free blood vessels or blood vessel displacement. Contraindications Autologous vein grafting is used to repair arterial defects. Due to the high arterial pressure, after the blood flow is restored, the vein may extend to a certain length under the influence of arterial pressure, which is about 10% to 15% of the length of the defect. The suture at the end of the graft vein has been This factor should be taken into account when trimming the vessel for suturing the other end. If the arterial defect is 3 cm, the appropriate length of the graft vein is 2.6 to 2.7 cm, so as to prevent the graft vein from being too long, and the blood flow is restored, causing the blood vessel to be distorted. Preoperative preparation 1. The blood supply to the blood vessel must be normal. The outer diameter should be similar to that of the receiving blood vessel. It should not be too different and should be of sufficient length. 2. After the supply of the vascular resection, it should cause blood circulation disorder (ischemia or blood stasis) in the donor area. 3. In general, arterial defects were reconstructed with arterial grafts and venous defects were reconstructed with vein grafts. However, clinical practice accounts for a small number of arteries, and a small number of arteries, and some arteries will cause insufficient blood supply in some areas. On the contrary, the location of the vein is superficial, the number is large, and it is easy to find. The superficial vein is removed for a period of time, and it does not cause reflux disorder. Therefore, in microsurgery, autologous vein grafts are often used to repair venous and arterial defects. 4. The autologous veins for transplantation include saphenous vein, small saphenous vein, external jugular vein, cephalic vein, expensive vein, dorsal vein and dorsal vein. The main saphenous vein, small saphenous vein and external jugular vein are too large, which is not suitable for the repair of small vessel defects. Generally, these vein branches are used. These vein branches have appropriate outer diameters and thin walls. They are the same as the superficial veins of the upper limbs, the back of the feet, and the dorsal veins of the hands. They are commonly used for autologous vein grafts. Surgical procedure 1. Determination of the length of the vascular defect: the length of the blood vessel must be removed according to the extent of the lesion, ie the length of the vascular defect. However, in the vascular defect caused by trauma, the length of the vascular defect measured is longer than the actual defect length due to vascular retraction, and the graft vessel can still be cut according to the measured defect length, and the excess portion is removed when suturing. 2. Transplantation of the graft: According to the defect length and outer diameter of the affected vessel, the appropriate blood vessel is selected for transplantation. Generally, a suitable superficial vein is selected for transplantation near the surgical field, but sometimes there is an arterial graft. For example, when the finger is replanted, one side of the finger artery is transplanted to repair the other side of the finger artery. After the transplanted blood vessels are determined, they are separated and ligated to cut off all branches. According to the length of the vascular defect in the recipient, the same length of vein or artery is cut. When cutting, the adventitial membrane of the graft vessel end should be stripped 1 to 2 mm. For vein grafting, the distal end of the vein should be marked with a suture. 3. Rinse and dilate the graft vessel: After the graft vessel is cut, insert the flat head into the lumen and use heparin saline to flush the blood in the cavity to avoid coagulation. In general, the separation of blood vessels often causes vasospasm. Before suturing, the tip of the vascular should be inserted into the vascular end with a slight extension for suturing. 4. Stitching: The graft vessel is embedded between the two ends of the defect vessel to prepare for suturing. If the arterial defect is repaired with autologous vein, the graft vein should be inverted so that the distal end of the vein is sutured to the proximal end of the artery, and the proximal end of the vein is sutured to the distal end of the artery. If the vein defect is repaired by vein, or the artery is repaired by arterial defect or venous defect, it is not necessary to invert. The proximal end and the proximal end can be sutured, and the distal end and the distal end can be sutured. When suturing, the end of the blood vessel and the end of the graft are sutured by end-to-end suture. After the suture is completed, the other end of the graft vessel can be held with the tip of the fistula; a little traction is applied to the other end of the defect vessel, and if the graft vessel is too long, the excess portion is cut and then sutured. 5. Restore blood flow: After the anastomosis is completed, first remove the small blood vessel clip at the distal end, and then remove the small blood vessel clip near the heart to restore blood flow. complication Pseudoaneurysm or arteriovenous fistula.