Vascular anastomosis is one of the most basic techniques of microsurgery, and the quality of anastomosis largely determines the success of the surgery. With the continuous development of microsurgical techniques, more and more new technologies have been used in vascular anastomosis, but hand suturing is still the "gold standard" method for microvascular anastomosis. This article summarized the advantages and disadvantages as well as application of traditional microvascular suturing techniques and improved techniques and their methods at home and abroad, aiming to provide reference for clinical application of microvascular suturing techniques.

Objective To assess the value of ultrasonography in the diagnosis of biliary stricture after liver transplantation (LT). Methods A total of 127 patients after LT in Liver Transplantation Center, the Third Afifliated Hospital of Sun Yat-sen University from January 2004 to March 2011 were included in this prospective study [116 males, 11 females;average age:(49±8) years old]. The informed consents of all patients were obtained and the ethical committee approval was received. Firstly, color Doppler ultrasound examination was performed in the patients. The ultrasound images were blindedly analyzed by two senior sonographers. The diagnostic indicators of biliary stricture ofter LT were hilar bile duct lumen narrowing, dilatation of bile duct, bile duct wall thickening, echo enhancement of bile duct wall. The endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography (PTC) results were taken as the gold standard for diagnosing biliary stricture after LT. The diagnostic sensitivity and speciifcity of the 4 single indicators and combined indicators were observed. Results The diagnostic sensitivity and speciifcity of the 4 single indicators hilar bile duct lumen narrowing, dilatation of bile duct, bile duct wall thickening, echo enhancement of bile duct wall were 0.68 and 1.00, 1.00 and 0.73, 0.71 and 0.87,0.80 and 0.70. The diagnostic sensitivity and speciifcity of combined indicators dilatation of bile duct+bile duct wall thickening or echo enhancement of bile duct wall reached 0.80 both. Conclusions Ultrasonography is useful in the diagnosis of biliary stricture after LT. Hilar bile duct lumen narrowing can be used as a direct indicator in the diagnosis of biliary stricture after LT. And the combined indicators dilatation of bile duct+bile duct wall thickening or echo enhancement of bile duct wall have higher reference value.

Objective:To investigate the techniques of digit-tip replantation with anastomosis of superior digital arch artery in children and to evaluate the clinical effects.Methods:From January 2020 to September 2022, 62 children (62 digits) with completely severed digit-tips were admitted to the Department of Paediatric Orthopaedics, Suzhou Ruihua Orthopaedic Hospital. All the injury planes were distal to the nail root. All arterial dissections were distal to the digital arterial arch with the vessel calibre from 0.15 mm to 0.35 mm. The superior arch arteries of the digital arterial arch were successfully anastomosed. After surgery, a significant blood flux to the replanted digit body were observed. Postoperative necroses or failures were analysed for the causes. All children with survived digit-tips were entered into scheduled follow-ups through a combination of visit of outpatient clinics or via WeChat and telephone reviews. Postoperative follow-up included digit body fullness, motion of distal interphalangeal joint, nail growth, scarring, and response of the replanted digit-tips to needling. Clinical outcomes were evaluated according to the evaluation criteria for finger replantation function.Results:Of the 62 replanted digit-tips, 56 survived after replantation. Two digits had wound infection after surgery, and survived by dressing change and applying sensitive antibiotics. Necrosis occurred in 6 replanted digit-tips, of which 2 necrotic digit bodies were amputated, and the stumps at the distal interphalangeal joint were repaired. The other 4 necrotic digits were healed after dressing change under the scab due to a smaller digit body. A total of 52 children (including 2 survivals from postoperative infection after dressing changes and 4 survivals with healing underneath-eschar after necrosis) and with 10 lost during follow-up (including 2 with stump repairs after necrosis). The follow-up period ranged from 2 to 30 months, with an average of 6 months. The shape and function of replanted digit-tips recovered well. According to the evaluation criteria for finger replantation function, 44 digits were of excellent, 6 of good, and 2 of fair.Conclusion:In children, the superior arch arteries of digital arterial arches of the digit-tips are small in diameter. However, the vessels in smaller calibres can be anastomosed, should proper surgical techniques are applied. Therefore, due to the satisfactory outcomes, microsurgeons should try the best efforts to replant a digit severed at the plane of digit-tip.