Shira 3-Jaw Clamp vs Acland® Clamp: What the Evidence Shows
The Shira 3-jaw microvascular clamp holds both vessel ends with a third, adventitia-holding jaw. That keeps the lumen everted, so the back wall can be sutured without flipping the clamp. In a randomised controlled trial of 30 patients (JPRAS, 2023), suturing time was roughly halved compared with Acland® clamps (p<0.001), with the same flap survival. In a trainee study (Plastic and Reconstructive Surgery, 2022), backwalling occurred in 0% of anastomoses with the 3-jaw clamp vs 30.8% with Acland® clamps.
Head-to-head results
| Outcome | Shira 3-jaw clamp | Acland® clamp | Source |
|---|---|---|---|
| Artery suture time | 15.9 min | 29.8 min | JPRAS 2023 RCT, p<0.001 |
| Vein suture time | 16.6 min | 33.4 min | JPRAS 2023 RCT, p<0.001 |
| Artery clamp time | 19.1 min | 33.1 min | JPRAS 2023 RCT, p<0.001 |
| Vein clamp time | 21.5 min | 37.1 min | JPRAS 2023 RCT, p<0.001 |
| Clamp flipping to reach the back wall | Not needed | Standard step | JPRAS 2023 RCT |
| Assistant needed | 2 of 15 cases | 14 of 15 cases | JPRAS 2023 RCT, p<0.001 |
| Surgeon-rated ease of use: excellent | 60% | 6.7% | JPRAS 2023 RCT |
| Flap survival | 93.3% | 93.3% | JPRAS 2023 RCT (no difference) |
| Backwalling / improper bites (trainees) | 0% | 30.8% | PRS 2022 |
| Clamp flips needed (trainees) | 0% | 38.5% | PRS 2022 |
| Anastomosis time (trainees) | 20.8 min | 32.3 min | PRS 2022, p=0.007 |
Why the third jaw helps
Design rationale, not a measured outcome:
- The third jaw holds the adventitia and everts the vessel edge, so each bite passes through the full wall.
- Both ends are held at an angle facing the surgeon, giving a 360° view without turning the clamp.
- Closing pressure is spread across three jaws instead of two.
When to use each
- Acland®-type 2-jaw clamps are the long-established standard: widely available, made in many sizes, and the clamp most surgeons trained on. Shira makes its own classic 2-jaw clamps: the 2-Jaw Microvascular Clamp with Approximator and the 2-Jaw Microvascular Single Clamp, Artery & Vein (Pair).
- The Shira 3-Jaw Microvascular Clamp with Approximator is built for end-to-end anastomosis. It suits cases where back-wall visibility and avoiding backwalling matter most, including training settings.
Clamp size codes
| Clamp size | Vessel diameter (mm) | Calibrated closing pressure (g) |
|---|---|---|
| 1A / 1V | 0.4–1.0 | 18–21 |
| 2AA / 2VV | 0.6–1.5 | 29–32 |
| 3AA / 3VV | 1.0–2.25 | 42–45 |
| HDD | 1.5–3.5 | 76–80 |
| RDD | 3.0–4.0 | 135–145 |
A = artery, V = vein. All clamps fit the Shira clamp applicator and the clamp sterilization case. See the full range of microvascular clamps.
Frequently asked questions
Is the 3-jaw clamp better than an Acland® clamp?
In a 2023 randomised trial of 30 patients, the Shira 3-jaw clamp roughly halved suturing time compared with Acland® clamps, with the same flap survival, and removed the need to flip the clamp. In a 2022 trainee study, backwalling was 0% with the 3-jaw clamp vs 30.8% with Acland® clamps. Acland® clamps remain the long-established standard, and the trial authors call for larger multicentre studies.
Does Shira make Acland®-type 2-jaw clamps?
Yes. Shira makes classic 2-jaw single clamps (sold in pairs) and 2-jaw clamps with an approximator, in stainless steel and anti-reflective black-coated finishes.
What sizes are available?
Artery and vein clamps in sizes 1, 2 and 3, plus HDD and RDD, for vessels from 0.4 to 4.0 mm. Each size has a calibrated closing pressure, from 18–21 g for size 1 up to 135–145 g for RDD.
Can I sterilise Shira clamps with my other instruments?
Yes. Shira clamps are autoclavable, and a dedicated clamp sterilization case keeps them organised.
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References
- Saha S, Mohammad A, Escandón JM, Chauhan S. Novel Microvascular Clamps to Aid Trainee Surgeon Education: Smarter Than Acland Micro Clamps? Plast Reconstr Surg. 2022;150(4):937e–938e. doi:10.1097/PRS.0000000000009530. PMID 35960914.
- Kohli A, Kala P, Dave A. A novel, innovative clamp with vessel eversion feature for end-to-end microvascular anastomosis. J Plast Reconstr Aesthet Surg. 2022;75(9). doi:10.1016/j.bjps.2022.06.068. PMID 35851497.
- Kohli A, Dave A, Dixit P, Katrolia D, Kumar P, Kala PC. Efficacy of novel, three jaw adventitia holding microclamps compared to Acland microclamps in patients undergoing end-to-end microvascular anastomosis: A randomized control trial. J Plast Reconstr Aesthet Surg. 2023;87:69–77. doi:10.1016/j.bjps.2023.09.022. PMID 37812846.
Acland® is a registered trademark of S&T AG. Shira Medtech is not affiliated with S&T AG.