Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
  Table of Contents / Epilogue
  Materials with a breaking strength of over 12 g. can be handled with fairly normal tactile sensation. Single-strand silk as it comes off the cocoon at 0-00075 in. (0-02 mm.) is the most flexible when wet (Buncke and Blackfield, 1963). All the metallic sutures except gold were found to distort tissue rather than lie comfortably in position after tying. Stainless steel wire 0-0016 in. (0-03 mm.) has been used successfully by others for slightly larger vessel repairs (Chace and Schwartz, 1963). Single strand nylon 0-0005 in. (0-01 mm.) is almost as workable as single-strand silk, and has been utilised for all recent anastomoses because of its greater strength. Ideally the needle should be the same size as the suture material. This is extremely difficult to achieve mechanically, since most metals are not rigid enough at these small diameters to penetrate tissue. Pure quartz is one of the most rigid materials available. However, needles made from tubing 0-002 in. (0-04 mm.) proved to be too brittle to be of practical value in spite of their fine penetrability. A variety of highly tempered stainless and high carbon tool steel needles measuring 0-003 (0.06 mm.) in diameter and drilled with a 0-0015 in. (0-03 mm.) hole for an eye were then used successfully1 (Fig. I). Unfortunately there still existed a 6-1 discrepancy between the needle and suture size. In addition threading these minute holes proved to be a tedious job. These problems have been solved by a recent technique whereby the end of the suture material itself is metallised to form a rigid needle approximately the same diameter as the suture material (Fig. 2). Such a " suture-needle " is ideal for microminiature vascular repairs since it produces a needle hole which is no larger than the suture, thereby reducing local trauma, leakage, and secondary clot formation.

  Clamps to immobilise the vessels and stay the flow of blood should be small, atraumatic, easy to apply and remove, and lie free in the field. If they are fixed to a remote stable point, any unusual movement of the animal or accidental jarring of the fixation is likely to destroy the set-up.

1 Tempress Research Co., Inc., 566 San Xavier Street, Sunnyvale, California.


FIG. 1. Small straight needle threaded with 10 micron nylon. Each division on the scale equals 1 mm.

FIG. 2. "Suture-needle." The end of the nylon thread has been metallised, rendering it rigid enough to penetrate tissue. The needle is only slightly larger than the suture, and blends in smoothly at the junction of needle and suture.

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