Background
The construction of microvascular anastomoses is a vital part of reconstructive surgery. Surgeon comfort and ease of access to relevant structures are of paramount importance in determining operative success. In lower limb reconstruction, recipient vessels may lie deep within the muscular compartments resulting in a suboptimal field in which anastomoses can be carried out.
Technique
In our unit, surgical background is loosely placed behind recipient vessels, with each end positioned under the end of a West self-retaining retractor. When the retractor is opened, the background ‘hammock’ is stretched taut, thereby elevating the vessels into the desired operative field in an atraumatic fashion (Figures 1 and 2).
Figure 1 .
Photo showing anterior tibial vessels deep within muscular compartment
Figure 2 .
Anterior tibial vessel elevated using the hammock technique
Discussion
This simple and cost-effective technique can improve access to deeper structures while providing a stable platform for microsurgery, and has been utilised by the senior author (SH) for several years for performing end-to-side microvascular anastomoses. The ‘hammock’ adaptation may result in faster operating times and fewer operative complications, compared with attempting fine-motor procedures at a suboptimal depth. Consideration must be given to the fact that the back wall of the vessel will be pushed slightly forward by the hammock, although in our experience this is minimal and would not compress the vessel lumen. Our described technique may also be adapted for use in other areas of the body, such as microvascular anastomosis in breast reconstruction, and sciatic nerve neurosynthesis in the thigh or pelvis.