<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:""><span style="font-family:Verdana;"> Intraoperative thrombo...<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:""><span style="font-family:Verdana;"> Intraoperative thrombosis during microvascular surgery is a nasty complication. Most intraoperative thromboses occur at the proximity of the anastomosis and microsurgical salvage techniques are needed to correct the complication. The aim of this article is to provide an overview of basic clinical patency testing and microsurgical salvage techniques. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> A</span></span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">search of the literature up to November 2020 was performed, using PubMed and Web of Science databases. Articles reporting on clinical intraoperative patency testing and/or salvage techniques in microvascular surgery were included. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">Comprehensive illustrations of intraoperative clinical patency testing includ</span></span><span style="font-family:Verdana;">e</span><span style="font-family:""><span style="font-family:Verdana;">: pulsation pattern, flicker test and milking test. The following surgical salvage techniques for both end-to-end and end-to-side intraoperative microvascular occlusion management are described: suture-line thrombectomy, thrombectomy through arteriotomy, anastomotic resection with complete re-anastomosis and, balloon extraction. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Decision making in surgical salvage techniques for microvascular thrombosis depends on localization of the thrombus and the surgeon’s experience and preference. In case of any doubt, it is better to reopen a few sutures and have a clear inspection of the anastomosis in order to prevent redo surgeries. This paper serves as a guide for especially the starting microsurgeon to clinically and surgically identify and handle an intraoperative microvascular anastomosis thrombosis and occlusion.展开更多
文摘<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:""><span style="font-family:Verdana;"> Intraoperative thrombosis during microvascular surgery is a nasty complication. Most intraoperative thromboses occur at the proximity of the anastomosis and microsurgical salvage techniques are needed to correct the complication. The aim of this article is to provide an overview of basic clinical patency testing and microsurgical salvage techniques. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> A</span></span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">search of the literature up to November 2020 was performed, using PubMed and Web of Science databases. Articles reporting on clinical intraoperative patency testing and/or salvage techniques in microvascular surgery were included. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">Comprehensive illustrations of intraoperative clinical patency testing includ</span></span><span style="font-family:Verdana;">e</span><span style="font-family:""><span style="font-family:Verdana;">: pulsation pattern, flicker test and milking test. The following surgical salvage techniques for both end-to-end and end-to-side intraoperative microvascular occlusion management are described: suture-line thrombectomy, thrombectomy through arteriotomy, anastomotic resection with complete re-anastomosis and, balloon extraction. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Decision making in surgical salvage techniques for microvascular thrombosis depends on localization of the thrombus and the surgeon’s experience and preference. In case of any doubt, it is better to reopen a few sutures and have a clear inspection of the anastomosis in order to prevent redo surgeries. This paper serves as a guide for especially the starting microsurgeon to clinically and surgically identify and handle an intraoperative microvascular anastomosis thrombosis and occlusion.