title: [Microsurgical venous automatic suture using double ring eversion system].
abstract: The quality of microsurgical sutures is a key to success in free flaps. Automatic devices are meant to improve safety and simplify microvascular anastomoses. We present the assessment of our clinical experience using automatic suture based on double ring eversion system.
  
  
  METHODS
  This system has been tested during an eighteen months period, in 72 consecutive venous end to end anastomoses. This technical innovation was used in 58 free flaps on a total of 52 patients. Indication for free flap was breast reconstruction (n=40), facial reconstruction (n=14), abdominal and limb reconstruction (n=4). Assessment was based on efficiency, anastomosis time, and thrombosis ratio in venous sutures.
  
  
  RESULTS
  The mechanical system made microsurgical procedure easier. It notably decreased coupling time compared to manual sutures. At the beginning, coupling time averaged eight minutes. It decreased to five minutes for the last ten cases. In our series, we noticed two venous thromboses (2.7%). In every case, emergency revision surgery allowed saving the flap. Thrombosis did not seem specifically due to the mechanical system.
  
  
  CONCLUSIONS
  Our positive experience together with good outcome published throughout literature lead us to routinely use double ring-based automatic suture. We chose this system in first line for every venous end to end anastomoses regardless of indication.
authors: Service de chirurgie plastique reconstructrice et esthétique, hôpital civil, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP n(o) 426, 67091 Strasbourg cedex, France. frederic.bodin@chru-strasbourg.fr
authors: F
authors: F
authors: Bodin
authors: A
authors: A
authors: Ganeval
authors: J-C
authors: JC
authors: Lutz
authors: S
authors: S
authors: Zink
authors: A
authors: A
authors: Wilk
authors: C
authors: C
authors: Bruant-Rodier
mesh_terms: D000714:Anastomosis, Surgical / Q000295:instrumentation; D004867:Equipment Design; D006801:Humans; D008866:Microsurgery / Q000295:instrumentation*; D013536:Suture Techniques / Q000295:instrumentation*; D014656:Vascular Surgical Procedures / Q000295:instrumentation*; D014680:Veins / Q000601:surgery*