Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3660_Библиотеки_им_академика_М_И_Перельмана

In (E), we illustrate an ideal result with a Hemashield roof patch graft repair. The clamps have been removed and the eld is dry. In (F), a similar roof patch is shown, but this was a re-operation case for recurrent stenosis, so the tissue planes surrounding the carotid sheath vessels are blurred and indistinct. Clearly with careful dis­section and meticulous technique a dry eld and a successful repair can be achieved. In (G), I show the use of a reinforcing band of Hemashield graft material to buttress an area of vessel thinning (see text for further details). In this particular case the plaque was heavily calcied, and after it was removed the residual wall was quite thin in parts. As I placed a single stitch to stop a small leak after de-clamping, the needle hole enlarged and contin­ued to ooze. In my experience, the placement of more sutures would have compounded rather than solved the problem. My solution, which we use occasionally in this type of situation, was to rst stop the oozing with direct pressure, which was effective, after which I placed an encircling band of patch material tied together at the top with two 6-0 Prolene-free sutures. This serves to reinforce the weak area and hopefully to guard against further leaks or aneurysm formation.