The instruments required for microvascular surgery are relatively few in number: straight and curved microforceps (Fig. 14.3a), microscissors (Fig. 14.3b), and

Fig. 14.3 Instruments for microvascular surgery.

a Straight and curved microforceps.

b Spring-handled microscissors, straight and curved (also: spring-handled needle holder with fine jaws). c Vascular clips and clip applier. d Approximators (double micro-clamps).

vascular clips and clip appliers (Fig. 14.3c). Microforceps or special spring-handled needle holders are excellent for suturing. Round-handled instruments are advantageous, as they can be rotated between the fingers and supported on the metacarpus. Vascular clips are needed to occlude the blood flow and keep the vessel ends from retracting into the soft tissues. Approximators (Fig. 14.3d) make it easier to hold the vessels in position and rotate them as needed to access the back wall. This special instrument set for microvascular suturing is complemented by various syringes, cotton swabs, and the suture material itself. Syringes are used to flush out the vessel ends with heparinized sodium chloride solution and to irrigate the vessels with lidocaine. Cotton swabs are used to soak up blood and irrigation fluid and for hemostasis. The suture material of choice is monofilament Ethilon. Monofilament material does not have the wick action of multifila-ment material and does not cause tissue friction. Suture size is determined by the diameter of the vessels to be anastomosed. Sizes 9-0 and 10-0 are recommended for vessel diameters of approximately 1 mm and 8-0 for diameters of 2-3 mm. We generally use 3/8 round-body needles such as MV-10, BV-4, and BV-21.

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