kết quả sử dụng bộ nối mạch máu trong vi phẫu CTCH

1. PRELIMINARY RESULTS USING
COUPLER
IN ORTHOPEDIC MICROSURGERY
AT CHO RAY HOSPITAL

2. STRUCTURE
I. Introduction.
II. Materials and methods
III. Results
IV. Discusstion
V. Conlution.

3. I.INTRODUCTION.
Traditional sutured anastomoses have an
accepted failure rate of 2–5%.
Vessel distortion due to size mismatches,
tension, or uneven sutures
The use of a microvascular coupling device for
the performance of anastomosis has gradually
become a routine part of microsurgical
reconstruction

4. I.INTRODUCTION.
The venous coupler was used in the early stages
(Denk et al., 1995; Sasson et al., 1994).
Coupler-assisted anastomoses are performed on
both, arteries and veins.
The overall success rate varies between 94% and
100% for venous and between 87% and 100% for
arterial anastomosis

5. II. MATERIALS
AND METHODS
During a year period from
June 2019 to June 2020, 3
microvascular free tissue
transfers and 3 arterry
anastomoses were
performed by the same
operator at Cho Ray hospital.
There were 4 male and two
female patients, with an
average age of 35 years
(range, 22–53 years).
A total of 3 free flaps were
performed for lower extremity
reconstructions.
All anastomoses were carried
out in an end-to-end manner.

6. II. MATERIALS
AND METHODS

7. II. MATERIALS
AND METHODS

8. III. RESULTS
Name Age Defect site Flap type Recipient vessel
Coupler size
(mm)
Coupler time
(min)
Follow up
(month)
PHAT HUU TRUONG 53 Right forearm Ulner artery 2 8
1
PHAM THI HUONG 42 Right leg
LDM Posterial tibial
pedicile
2 30
10
TRAN MINH LUAN 22
Left forearm
Radial artery 2 12
11
NGUYEN VAN QUI 26 Right forearm Radial artery 2 10
11
LE MINH TIEN 24 Left leg
ALT Posterial tibial
pedicile
2 35
10
TRAN THI THU SANG 44 Left leg LDM Anterior tibial pedicle 2.5 45
8

9. III. RESULTS
Nine anastomoses in six patients were performed with
the coupler: 3 of them were venous and 6 was arterial.
All cases were performed with a 2.0 mm to 2.5 mm
coupler ring.
There were no free-flap failures

10. III. RESULTS

11. III. RESULTS

12. IV. DISCUSSION:
 In our current study, we used a microvascular anastomotic coupler to
perform free tissue transfers for reconstruction of the extremities and
repaid artery injuries.
 Two different ring sizes with inner diameters of 2.0, 2.5 were available in
our series.

13. IV. DISCUSSION:
There are several hypotheses supporting the advantages of the coupler device.
 First, there is a considerable time saving over a sutured anastomosis.
 The second advantage is that no foreign bodies stay inside the lumen, unlike
conventional hand-sewn suture
One big disadvantage of the application of the coupler device is the learning time.

14. IV. DISCUSSION:
We believe that a hand-sewn micro-anastomosis is obligatory in several indications:
 The artery is too thick-walled.
 Since adequate eversion of the edges over the device becomes technically difficult.
 Leading to either intimal injury or significant reduction in intraluminal diameter.
 When there exists donor and recipient arterial luminal diameter discrepancies of greater than 1.0mm.
 when it is necessary to avoid using micro-anastomoses within the zone of injury.

15. V. CONLUTION
 Our study confirms the capability of the mechanical coupler
device to anastomose vessels in an end-to-end fashion in
microsurgery.
 It is both reliable and timesaving.
 We highly recommend the coupler device as a safe, fast and
reliable adjunct for free tissue transfers.

16. THANK YOU