Efficacy, Efficiency, and Safety of a Poly-L-lactic Acid Cuff Tube Assisting for Microvascular Anastomosis

BACKGROUND: Vascular anastomosis is a cornerstone of microsurgery. Anastomosis time and vessel patency significantly influence surgical success. The disadvantages of the traditional hand-sewn method requires a high technical threshold, prolonged surgical time, and an increased risk of vessel occlusion or leakage. Consequently, developing a reliable device to facilitate vascular anastomosis is essential in microsurgery. METHODS: In this study, a poly-L-lactic acid (PLLA) cuff tube with favorable mechanical and biological properties was employed for anastomosis using a nonsuture cuff technique. Its biocompatibility was comprehensively evaluated in vitro. Its surgical feasibility was validated in vivo using a rat syngeneic orthotopic hindlimb transplantation model. Vessel patency and anastomotic time were documented, and histopathological analysis was performed. RESULTS: Both L929 cells viability assay and mammalian chromosomal aberration test showed that the PLLA cuff tubes were noncytotoxic. The mean time of anastomosing a single vessel was 18.9 min using the cuff tube compared with 28.8 min using the hand-sewn method. All vessels remained patent in the cuff technique group, while 3 cases of total occlusion occurred in the hand-sewn group. Histopathological analysis revealed no obvious signs of inflammation or immune response associated with PLLA cuff tube implantation. CONCLUSIONS: PLLA cuff tube is a safe and effective alternative to traditional hand-sewn method, with strong potential for clinical application in microvascular anastomosis.