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Ring-Pin-Anastomosentechnik

Klinische Langzeiterfahrungen mit dem mechanischen Ring-Pin-System für mikrovaskuläre Anastomosen in der rekonstruktiven Kopf-Hals-Chirurgie

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Zusammenfassung

Hintergrund

Mikrovaskuläre Anastomosen stellen einen der kritischsten Aspekte beim freien Gewebetransfer dar. Weil mikrochirurgische Nahttechniken kompliziert und zeitaufwendig sind, wurde nach anderen Anastomosetechniken gesucht. Eine solche Methode ist das Ring-Pin-System.

Methode

Von Januar 1996 bis Oktober 2001 wurden bei 48 Patienten Defektrekonstruktionen mit gestielten, mikrovaskulär anastomosierten Unterarmlappen vorgenommen. Bei 20 Patienten wurde die venöse Anastomose mit dem Ring-Pin-System in End-zu-End-Technik durchgeführt. Die klinischen Ergebnisse wurden mit 28 Patienten verglichen, bei denen die Anastomosierung der Vene mit 9-0-Prolene-Naht in End-zu-End-Technik erfolgte.

Ergebnisse

In der Gruppe mit Ring-Pin-Anastomose (n=20) zeigten 2 Gewebelappen eine venöse Stauung innerhalb der ersten 24 postoperativen Stunden. Nach der Revision waren die Transplantate gut durchblutet. In der Gruppe mit genähten Gefäßanastomosen (n=28) wurde ein Gewebelappen durch eine venöse Thrombosierung ischämisch und musste teilweise entfernt werden. Die Anastomosezeit konnte durch Verwendung des Ring-Pin-Systems deutlich verkürzt werden.

Schlussfolgerungen

Die venöse End-zu-End-Anastomosierung mit dem Ring-Pin-System ist nach einer relativ kurzen Übungsphase vergleichsweise einfach und schnell durchzuführen. Langzeitergebnisse zeigten eine gute Gewebeverträglichkeit des Materials sowie eine gute Durchblutung der Transplantate.

Abstract

Background

Microvascular anastomosis remains one of the most critical aspects of free tissue transfer. Since microsurgical suture techniques are complicated and time-consuming, other techniques of anastomosis have been created. One of these is the ring-pin system.

Methods

Between January 1996 and October 2001, 48 patients underwent reconstruction with a free radial forearm flap. In 20 patients the venous anastomosis was carried out using a ring-pin system with end-to-end technique. The clinical results were compared to the other 28 patients in whom the anastomosis was sutured with 9-0 prolene.

Results

In the group using ring-pin anastomosis (n=20), two flaps showed venous congestion within 24 h postoperatively. After revision the flaps were well perfused. In the other group with sutured vessels (n=28), a transplant became ischemic in one patient due to venous thrombosis and had to be partly removed. The time of anastomosis was considerably shortened by the use of the ring-pin system.

Conclusions

The venous end-to-end-anastomosis using the ring-pin system can be carried out relatively easily and rapidly after a comparatively short period of training. Long-term results have shown good tissue tolerance of the material and sufficient blood circulation of the grafts.

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Authors and Affiliations

  1. Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Martin-Luther-Universität , Halle-Wittenberg, Germany

    E. Röpke, A. Berghaus &  M. Bloching

  2. Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Martin-Luther-Universität Halle-Wittenberg, Magdeburgerstraße 12, 06097 , Halle (Saale), Germany

    M. Bloching

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  1. E. Röpke
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  2. A. Berghaus
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  3. M. Bloching
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Röpke, E., Berghaus, A. & Bloching, M. Ring-Pin-Anastomosentechnik. HNO 52, 121–124 (2004). https://doi.org/10.1007/s00106-003-0895-x

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