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Table of Contents
LETTER TO THE EDITOR
Year : 2021  |  Volume : 29  |  Issue : 3  |  Page : 193-194

A rollboard for microvascular anastomosis: Cellulose eye spear


1 Department of Plastic, Reconstructive and Aesthetic Surgery, Gebze Medical Park Hospital, Istanbul, Turkey
2 Department of Plastic, Reconstructive and Aesthetic Surgery, Baskent University, Ankara, Turkey

Date of Submission05-Sep-2020
Date of Acceptance13-Jan-2021
Date of Web Publication29-Jul-2021

Correspondence Address:
Dr. Burak Ozkan
Department of Plastic, Reconstructive and Aesthetic Surgery, Baskent University, Ankara-06900
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjps.tjps_97_20

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How to cite this article:
Ercin BS, Ozkan B, Uysal CA, Ertas NM. A rollboard for microvascular anastomosis: Cellulose eye spear. Turk J Plast Surg 2021;29:193-4

How to cite this URL:
Ercin BS, Ozkan B, Uysal CA, Ertas NM. A rollboard for microvascular anastomosis: Cellulose eye spear. Turk J Plast Surg [serial online] 2021 [cited 2021 Sep 17];29:193-4. Available from: http://www.turkjplastsurg.org/text.asp?2021/29/3/193/322677



Dear Editor,

Backgrounds for microvascular anastomosis are used for isolating the operative field from anastomosis area for lesser interaction of the vessel intima and microvascular thread to surrounded tissues.[1] Backgrounds facilitate a clearer operative field and help the surgeon to focus on anastomosis. Several materials in different colors such as green and blue have been used as backgrounds such as silicon, plastic sheets, papers, parts of surgical gloves, and suture.[2] Apart from the reported backgrounds in the literature, we have been using Cellulose Eye Spear (Weck-Cel, BVI, USA) sponges for microsurgical anastomosis for a period of time. Cellulose Eye sponges are highly absorbent cellulose materials generally used for limbal flap elevation and fluid control in ophthalmic surgery.[3] The triangular shape and semi-rigid texture of the sponge is suitable for using it as the background of microvascular anastomosis. In this letter, we would like to present the advantages that we experience with Weck-Cel in the end-to-end fashion anastomosis.

After the application of double-clamp microvascular approximator, Weck-Cel sponge is placed under the anastomotic field. Because of the textured surface of the Weck-Cel, it holds the vessels and provides a counter-rolling movement while Weck-Cel advanced forward and back [Video 1]. In this way, the surgeon can change the anastomosis field of view by moving the Weck-Cel sponge, and continue anastomosis without further manipulation or assistance. With the help of this rolling movement, surgeons' focus does not change and anastomosis can be performed from the same visualization angle. This provides an optimum view that allows control of the intima for each stitch during the procedure [Figure 1]. Size of the Weck-Cel can be modified according to surgical field and the size of the vessels. While the actual size of Weck-Cel is suitable for free flap surgery, Weck-Cel can be trimmed with tangential excision in digital artery repair.
Figure 1: Illustration demonstrates counter-rolling movement of the vessels between double clamps during advancement of Weck-Cel

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We think this technique could offer convenience to anastomosis leading by a single surgeon in the absence of an assistant in the operative room. Özdemir et al. described a polyproline rigid background for traction of the stay sutures during anastomosis for surgeons working alone. However, this model is time-consuming to prepare and hard to place because of its rigidity.[4] Tajima used a silicone background for holding stay sutures.[5] The main drawback of silicone is its softness and possible bending during anastomosis. In our technique, there is no need for stay sutures. Thus, we eliminate the risk of torn due to traction of stay sutures. In addition, Weck-Cel absorbs peri-anastomosis fluids such as blood or irrigation solutions and provides a clear operative field. We experienced that enlargement of Cellulose Eye Spear affords additional support and elevates vessels above. The main drawback of Cellulose Eye Spear is its white color that changes to red gradually during the procedure. However, we have not encountered a difficulty in this color change. As a summary, Weck-Cel is a practical and reliable microsurgical background that acts as a vessel rollboard and helps the surgeon with minimum manipulation to microvascular anastomosis and without the need of stay sutures or assistance.

Acknowledgment

We would like to thank Nilgun Ozkan for medical illustrations.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
O'Brien BM, Henderson PN, Bennett RC, Crock GW. Microvascular surgical technique. Med J Aust 1970;1:722-5.  Back to cited text no. 1
    
2.
Isogai N, Kamiishi H. Usefulness of the silicone microsurgical background. Plast Reconstr Surg 1989;84:366-7.  Back to cited text no. 2
    
3.
Rainin EA. Limbal-based conjunctival flap retractor. Ann Ophthalmol 1975;7:599-601.  Back to cited text no. 3
    
4.
Özdemir H, Sönmez E, Keçik A. Polypropylene background traction device for microvascular anastomosis. Microsurgery 2010;30:419-21.  Back to cited text no. 4
    
5.
Tajima S. Trap-door technique in the background for holding stay sutures in the microvascular anastomosis. Plast Reconstr Surg 1980;66:463-5.  Back to cited text no. 5
    


    Figures

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