Paul Cederna, MD, Adeyiza Momoh, MD, Albert Shih, Ph.D., and Jeffrey Plott
Approximately 5.8 million reconstructive procedures were performed by board certified plastic surgeons in 2014. Free tissue transfers from one part of a patient’s body to another provide a means for reconstructive surgeons to repair and replace body parts, restoring appearance and in many cases function and feeling. The most common reasons for patients to undergo tissue transfers is after tumor extirpation (i.e. breast cancer reconstruction), trauma, burn injury, or to restore absent function associated with congenital anomalies. In free tissue transfers, veins and arteries are surgically reattached in a procedure called microanastomosis. This procedure helps to restore blood circulation, and consequently, oxygen supply to the transferred tissue.
There are two common methods of performing a microvascular anastomosis: (1) using a commercially available microvascular anastomotic coupler and (2) microsutures. Taking advantage of the flexibility of veins, the coupler provides a fast and secure microanastomosis. A key step in successfully using this coupling device is everting the vessel wall over a set of stainless steel pins. However, since arteries have a stiffer and more muscular wall than veins, it is much more difficult for the surgeon to evert the arterial wall over the pins of the coupler. This difficulty compromises the potential outcome with reduced anastomotic patency rates. As a result, arterial microanastomosis is currently performed by manual suturing. Because most vessels are 1-3mm in diameter, suturing is a laborious process that requires extensive training and takes approximately 23.5 minutes per vessel.
Plastic surgeons Drs. Paul Cederna and Adeyiza Momoh, in collaboration with Mechanical Engineers Dr. Albert Shih and Jeffrey Plott, have developed a microsurgical tool that everts arterial walls over the coupler pins when used in conjunction with the microvascular anastomotic coupler. This device reduces arterial microanastomosis procedure time to 5 minutes, while minimizing required operator skill, concentration, and fatigue during long, complex operative procedures.
The Coulter project will involve prototype refinement and in vivo pre-clinical studies of the device to validate coupling efficiency and anastomosis time.
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