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 placing the back wall stitches first.
The first stitch is placed, at the deepest point, now that it is still relatively accessible. Depending on the size of the vessel one could follow a 9- or 6- stitch concept. However in this particular case 6 stitches might not suffice for safe closure of the anastomosis and in a 9-stitch concept a needle test would be less sensitive given that stitches 3, 6 and 8 are not placed in the middle between their neighbors. Consequently we use a 180-degree, 8 stitch concept as indicated.
Anastomosis – 12 stitches, far side first
To perform the first stitch, the needle is passed from the outside into one vessel end and from the inside out of the other end on the far side of the vessel. The stitch is then tied to a knot underneath the vessel. One suture end of the knot isleft long for ease of handling. The second stitch is placed 180 degrees from the first and again one suture end of the knot is left long. Stitch three is placed in the middle between the first two and a needle test is performed. In case it is negative, repeat the stitch. Place stitches 4 and 5 on the front wall and flip over the approximator to complete the anastomosis.
If your anastomosis is patent, cover it up with moist gauze and leave it alone for 20 minutes. Then test its patency once more.
You can use either femoral, abdominal or neck vessels for the next exercise.