Horizontal mattress technique for anastomosis of size-mismatched vessels
Bibliographic record
Abstract
T he patency of the microvascular anastomosis is paramount for flap survival in microsurgery (1).In addition to endothelial dysfunction and hypercoagulability, flow turbulence is an essential part of Virchow's triad and must be minimized to prevent anastomotic thrombosis (2).Unfortunately, microsurgeons occasionally encounter cases in which mismatched vessels must be anastomosed, which is a situation at high risk for flow turbulence and thrombosis (1).Mismatch, defined as a vessel diameter ratio of ≥1.5:1, is typically encountered in 33% of arterial and 50% of venous anastomoses (3).Multiple, technically demanding techniques to overcome this problem have been described including coupling devices, forced dilation of the smaller vessel, oblique cuts, fish-mouth incisions, end-to-side anastomoses and interpositional grafts (1).We describe a simple technique using horizontal mattress (HM) sutures based on our previously published work in size-appropriate arteries (4).We believe this can overcome the problem of size mismatched arteries without excessive manipulation of the vessels in an end-to-end fashion.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".