Advanced/optional: Anastomotic concept – 12 stitches, far side first
In clinical practice, flipping over the approximator will not always be possible.
This can be the case when working in very tight spaces, or when having to anastomose very short vessel ends. In some cases, the solution is to place the first stitches on the aspect of the anastomosis that is hardest to reach in either position of the approximator, while the vessel stumps can still be moved freely. If the approximator can be positioned flat on the background, but not flipped over, the first stitch is placed here, at the deepest point. Stitches two through five are placed as indicated. Stitch six is performed on the upper aspect: here. Stitches seven through twelve are performed as indicated.
A more complex scenario in which the approximator cannot be positioned flat on the background and stands more upright will be presented in the Rat Neck Vessels Model.