title: Clampless anastomosis with an intraluminal thermosensitive gel: first application in reconstructive microsurgery and literature review.
abstract: Microvascular clamps of various designs provide a bloodless field for a safe anastomosis but can cause intimal lesions, occupy space in confined sites and have a risk of backwalling due to vessel flattening. They are often insufficient in their haemostatic effect in plaque-filled atherosclerotic vessels. A new, CE-certified thermosensitive gel (LeGoo™) clinically proven in cardiovascular surgery allows a clampless microanastomosis technique. We operated on a series of five consecutive patients aged 24-71 years with six flaps for lower-extremity reconstruction using a clampless anastomosis technique with LeGoo™. We transplanted one fabricated chimaeric fibula plus gracilis, three gracilis muscle and one anterolateral thigh (ALT) flap. Pre- and postoperative protocols were similar to a 'standard' procedure with micro-clamps. All flaps survived completely except for a small area on fibula skin island, which was unrelated to gel use. The gel-assisted technique has a quick learning curve, according to this case series. The veins should be sutured first to prevent stasis in the flap. The gel provides circular stenting and gentle distension of the vessels for a safe and blood-free anastomotic site. It is completely dissolved after completion of the anastomosis with cold saline irrigation. Repolymerisation in the periphery will not occur, making it safe for microvascular flap surgery. From the experiences from this series and other specialities, the use of the thermosensitive gel LeGoo™ permits a safe clampless microanastomosis technique minimising mechanical vessel manipulation and compression. This makes it an attractive alternative to micro-clamps, especially for atherosclerotic arteries and confined anastomosis sites.
authors.affiliation: Department of Plastic, Hand and Reconstructive Microsurgery, BG Trauma Center, Professor Kuentscher Strasse 8, D-82418 Murnau, Germany. giesslerplasticsurgery@hotmail.com
authors.forename: G A
authors.initials: GA
authors.lastname: Giessler
authors.forename: G T
authors.initials: GT
authors.lastname: Fischborn
authors.forename: A B
authors.initials: AB
authors.lastname: Schmidt
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005782:Gels / Q000627:therapeutic use*; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D035002:Lower Extremity / Q000601:surgery; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000098:blood supply*; D013525:Surgical Instruments; D013718:Tensile Strength; D013697:Thermosensing; D014014:Tissue Adhesives / Q000627:therapeutic use; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods; D055815:Young Adult
chemical_list: D005782:Gels; D014014:Tissue Adhesives