Grants Funded

Abstract
This project seeks to provide an alternative method of vascular anastomosis that improves upon gold standard suture repair in the plastic and reconstructive field.
Microsurgical repair of arteries and veins is a time-consuming and technically challenging skill that requires patience and surgical precision. The necessity for rapid and effective anastomosis continues to grow in both the reconstructive microvascular and trauma/military arenas.
Photochemical tissue bonding (PTB) is a technique that crosslinks collagen using a photoactive dye and green light, and can rapidly seal blood vessel ends in a procedure that requires considerably less skill and could be performed in an emergent trauma situation. Pilot studies performed in this lab have demonstrated the feasibility of this technique in rodents and rabbits on the microvascular scale. Coupled with an intraluminal dissolvable glass stent, we hypothesize that this technique could be applied to a larger animal model (swine) which would serve as a precursor for translational human studies, resulting in a rapid and watertight vascular anastomosis with minimal endothelial damage and clinically acceptable patency rates.
A total of six male Yorkshire pigs (46-50kg) will undergo bilateral carotid artery transection and will be randomized to either repair with standard microsuture (SR), SR over a dissolvable glass stent, or PTB over stent. Each animal will receive one dose of heparin after removal of vessel clamps. Time to anastomosis, aneurysm or hematoma formation, and degree of intimal hyperplasia will be measured via gross observation and histology. Patency will be determined immediately, at 1 hour, and at 1 week by Doppler ultrasound flow studies.
The ultimate goal is to introduce an alternative, rapid, and feasible method of sutureless vascular repair that can be utilized in free flap and hand/forearm reconstruction, as well as limb reconstruction in the emergent situation with minimal inflammatory and prothrombotic complications.

Biography
Dr. Winograd is a reconstructive plastic surgeon at Massachusetts General Hospital. He completed both his general and plastic surgery training at Johns Hopkins Hospital including a two year research fellowship in the Plastic Surgery Research Laboratory. He then went on to do an additional year of fellowship training in Hand and Microsurgery at Washington University in Saint Louis in the Division of Plastic Surgery. His research focus has been the improvement of outcomes following microsurgical repair of peripheral nerve injuries. With grant support from the Plastic Surgery Foundation and ASPS, as well as the Academic Scholar program of the American Association of Plastic Surgeons, he has developed a translational research program which investigates the use of photochemical tissue bonding to decrease scarring at neurorrhaphy sites and better isolate the regenerative environment necessary to promote optimal neural regeneration. He is currently funded by the Department of Defense to further investigate the benefits of this technique combined with large gap peripheral nerve injuries and nerve grafting. Most recently, with the current grant support from PSF, the photochemical tissue bonding is being used to improve microsurgical repair of blood vessels, with the added implementation of a dissolvable glass stent to aid in the technical performance and stabilization of the anastomosis.