title: Technology-assisted and sutureless microvascular anastomoses: evidence for current techniques.
abstract: BACKGROUND
  Since the birth of reconstructive microvascular surgery, attempts have been made to shorten the operative time while maintaining patency and efficacy. Several devices have been developed to aid microsurgical anastomoses. This article investigates each of the currently available technologies and attempts to provide objective evidence supporting their use.
  
  
  METHODS
  Techniques of microvascular anastomosis were investigated by performing searches of the online databases Medline and Pubmed. Returned results were assessed according to the criteria for ranking medical evidence advocated by the Oxford Centre for Evidence Based Medicine. Emphasis was placed on publications with quantifiable endpoints such as unplanned return to theatre, flap salvage, and complication rates.
  
  
  RESULTS
  There is a relative paucity of high-level evidence supporting any form of assisted microvascular anastomosis. Specifically, there are no randomized prospective trials comparing outcomes using one method versus any other. However, comparative retrospective cohort studies do exist and have demonstrated convincing advantages of certain techniques. In particular, the Unilink™/3M™ coupler and the Autosuture™ Vessel Closure System® (VCS®) clip applicator have been shown to have level 2b evidence supporting their use, meaning that the body of evidence achieves a level of comparative cohort studies.
  
  
  CONCLUSIONS
  Of the available forms of assisted microvascular anastomoses, there is level 2b evidence suggesting a positive outcome with the use of the Unilink™/3M™ coupler and the Autosuture™ VCS® clip applicator. Other techniques such as cyanoacrylates, fibrin glues, the Medtronic™ U-Clip®, and laser bonding have low levels of evidence supporting their use. Further research is required to establish any role for these techniques.
authors: Jack Brockhoff Reconstructive Plastic Surgery Research Unit, Department of Anatomy and Cell Biology, University of Melbourne, Melbourne, Vic., Australia.
authors: George F
authors: GF
authors: Pratt
authors: Warren M
authors: WM
authors: Rozen
authors: Angie
authors: A
authors: Westwood
authors: Angela
authors: A
authors: Hancock
authors: Daniel
authors: D
authors: Chubb
authors: Mark W
authors: MW
authors: Ashton
authors: Iain S
authors: IS
authors: Whitaker
mesh_terms: D000714:Anastomosis, Surgical / Q000295:instrumentation / Q000379:methods*; D004867:Equipment Design; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use; D006801:Humans; D008866:Microsurgery / Q000295:instrumentation / Q000379:methods* / Q000639:trends; D014014:Tissue Adhesives / Q000627:therapeutic use; D058106:Wound Closure Techniques / Q000295:instrumentation
chemical_list: D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives