Efficacy of novel, three jaw adventitia holding microclamps compared to Acland microclamps in patients undergoing end-to-end microvascular anastomosis: A randomized control trial.

Objective: To evaluate the efficacy of three jaw adventitia holding (TADH) microclamps in end-to-end microvascular anastomosis.

Background: Acland clamps, though highly efficacious, require a steep learning curve and are associated with complications such as back walling and incomplete bites.

Methods: A single center, parallel group, 30-patient randomized clinical trial was conducted with a 1:1 allocation ratio in Acland and TADH microclamp groups. Primary outcome was time taken for microvascular anastomosis in terms of arterial and venous clamping and suturing time. Secondary outcomes included ease of use, need for clamp flipping and adventitia trimming, and need for assistance and flap survival.

Results: TADH microclamps were found to be beneficial when compared to Acland microclamps in end-to-end microvascular anastomosis, in terms of artery clamp time (19.07 ± 3.751 min, 95% CI 10.058-17.942, p < 0.001), artery suture time (15.87 ± 3.357 min, 95% CI 10.660-17.206, p < 0.001), vein clamp time (21.50 ± 3.849 min, 95% CI 12.131-19.469, p < 0.001), and vein suture time (16.58 ± 3.147 min, 95% CI 13.232-20.368, p < 0.001). The TADH microclamps did not require flipping to enable suturing of the posterior walls of the vessel. Statistically significant difference was found in surgeon-reported ease of use with TADH microclamps (Chi-square value 9.867, p < 0.001). Statistically significant difference was found in relation to the need for assistance with TADH microclamps (Chi-square value 19.286, p < 0.001).

Conclusion: This study found TADH microclamps to be faster, easier to use, and clinically efficacious in reducing the anastomosis time compared to those of the Acland clamps.