Invited commentary

Invited commentary their air pressure clamp showed excellent patency as their new clamp at a reasonable price but also can man- compared to vessels done with type two clamp and type age to market it to reconstructive microsurgeons all over three clamp. The results of group one, two and three in the world. experiments two and three is difficult to determine from the text. In microvascular surgery today currently available References microvascular clamps have closing pressures less than 1. Kroll SS, Schusterman MA, Reece GP, Miller MJ, Evans GRD, 30 g per mm 2, are small, lightweight, mechanically sim- Robb GL, Baldwin BJ (1996) Choice of flap and incidence of ple and have flat non-slip jaws. I have been satisfied free flap succes. Plast Reconstr Surg 98:459 with these clamps, although I am certain that some endo- 2. Suominen E, Asko-Seljavaara S, Tuominen H, Tukiainen E thelial damage occurs. It is highly unlikely in any micro- (1995) Free microvascular TRAM flaps for breast reconstruc- surgical case to have microvascular clamps in place for tion: the first 50 patients. Eur J Plast Surg 18:1 more than 60 min, the time I feel that it takes before sig- 3. Suominen S, Asko-Seljavaara S (1995) Free flap failures. Mi- crosurgery 16:396 nificant injury occurs. Simple endothelial sloughing does not increase thrombosis rates, experimentally [1]. Thrombosis rates occur after the tunica media is dam- aged and loss of muscle function causes aneurysmal di- latation with stasis of flow and eventual fibrin deposition [2]. Stamatopoulos and colleagues have shown experi- mentally that time of occlusion, not pressure, is more significant after more than 60 min of occlusion [3]. In N.B. Meland the clinical situation if clamping with currently available Mayo Clinic Scottsdole, 13400 East Shea Boulevard, Scottsdole, clamps is carried out at less than 60 min of time, and the AZ 85259, USA clamp is moved to a different location on the vessel, sig- nificant thrombosis has not been thought to be a factor in our practice secondary to microvascular clamping isch- In this article Dr. Wu and colleagues have utilized an ex- emia. It is our feeling that our microvascular failures perimental model using rat femoral vessels to determine have been more so due to technical failures with the whether clamp pressures utilizing standard microvascu- anastomosis than endothelial sloughing at the site of our lar clamps versus their newly invented adjustable air microvascular clamping. pressure microvascular clamp will have an effect on pa- It would have been very helpful for the authors to de- tency rates and endothelial damage in microvascular sur- scribe the engineering, development and appearance of gery. They include a clinical series of 119 anastomoses their air pressure of microvascular clamp with photogra- in 43 patients with various clinical problems. phy included in the manuscript. This is an ingenious idea The study encompassed three groups of rats. Group 1 and may have a place in macro or microvascular surgery received clamping with their air pressure vascular clamp since anything that we can do to limit endothelial, and adjusted to stop flow. Group 2 a vascular clamp of type especially tunica media vessel injury during vascular oc- SSW-3. Group 3a vascular clamp of type SXXI. The au- clusion is important. I commend the authors on the de- thors do not go into detail about the shape of these velopment of their clamp, but do not feel this manuscript clamps, the closing pressures; or the width of the jaws of and study in its current form has proven its use to be these clamps. Unfortunately, they include no diagram, beneficial. no detail, and no description of their air pressure vascu- lar clamp. I believe all three of these would have been essential to really discuss the importance of this paper. References In experiment one, they measured the endothelial dam- age after clamping for one hour and two hours, this was 1. Thurston JB, Buncke HJ, Chater NL, Weinstein PR (1976) A done with scanning electron microscope and an operat- scanning electron microscopic study of microarterial damage ing microscope. Experiment two determined pressure and repair. Plast Reconstr Surg 57:197-203 2. Stark RH, Sanger JR, Matloub HS (1984) A new microvascular measurements with the use of a nylon thread attached to clamp for protection of experimental ischemia. Microsurgery a transducer. Experiment three, patency rates after anas- 5:202-206 tomosis with different clamps were evaluated by Dopp- 3. Stamatopoulos C, Biemer E, Duspiva W, Brumel G (1980) Mi- ler ultrasound and direct visualization at seven days. The crovascular damage caused by the application of surgical mi- results of experiment one are recorded in table one. No croclips: the effects of pressure and time. Int J Microsurg statistical analysis was carried out but vessels done with 2:(December) N 3-4 European Journal of Plastic Surgery Springer Journals

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Medicine & Public Health; Plastic Surgery
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